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Early Symptomatic Worsening During Treatment With Fluoxetine in Major Depressive Disorder
- Source :
- The Journal of Clinical Psychiatry. 68:52-57
- Publication Year :
- 2007
- Publisher :
- Physicians Postgraduate Press, Inc, 2007.
-
Abstract
- Background A subset of patients experience worsening of depressed mood after beginning antidepressant treatment, which could represent the natural history of the illness or a treatment-related effect. While patterns of response have been examined as possible predictors of outcome, the clinical correlates and implications of early worsening per se have not been investigated. Method In a post hoc analysis, we studied the clinical correlates of early worsening in a large sample of outpatients (N = 694) diagnosed with a DSM-III-R-defined major depressive episode and treated with fluoxetine (20 mg/day) for up to 12 weeks. We defined early worsening as an increase of at least 5 points on a modified 17-item Hamilton Rating Scale for Depression (mHAM-D, including reverse vegetative symptoms) compared to the previous visit, and occurring during the acute phase of treatment. The primary analysis compared remission and response at week 12 between those patients with and without worsening. Results In our sample, 211 patients (30.4%) experienced early worsening of depression. An increase in mHAM-D score at week 2, 3, 4, or 6 was associated with a significantly lower probability of remission and response at both week 8 and week 12, while no significant difference was observed in study discontinuation. Baseline features, including gender, age, mHAM-D score at entry, number of previous depressive episodes, and duration of illness were not associated with the development of early worsening during fluoxetine treatment. Conclusion Early clinical worsening is common and associated with a decreased likelihood of achieving remission.
- Subjects :
- Adult
Male
medicine.medical_specialty
Fluoxetine
Internal medicine
Post-hoc analysis
Prevalence
medicine
Humans
Major depressive episode
Psychiatry
Depression (differential diagnoses)
Retrospective Studies
Clinical Trials as Topic
Depressive Disorder, Major
Hamilton Rating Scale for Depression
Retrospective cohort study
Middle Aged
Prognosis
medicine.disease
Discontinuation
Psychiatry and Mental health
Disease Progression
Major depressive disorder
Female
medicine.symptom
Psychology
Selective Serotonin Reuptake Inhibitors
medicine.drug
Subjects
Details
- ISSN :
- 01606689
- Volume :
- 68
- Database :
- OpenAIRE
- Journal :
- The Journal of Clinical Psychiatry
- Accession number :
- edsair.doi.dedup.....efcad7da9a4ef744736e9d2fa56c9ab6