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Gorwood P, Benichou J, Moore N, Wattez M, Secouard MC, Desobry X, Picarel-Blanchot F, de Bodinat C. Agomelatine in Standard Medical Practice in Depressed Patients: Results of a 1-Year Multicentre Observational Study In France. Clin Drug Investig 2020; 40:1009-1020. [PMID: 32729068 PMCID: PMC7595961 DOI: 10.1007/s40261-020-00957-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Background and Objectives Non-interventional studies are a valuable source of evidence that is complementary to traditional randomised, blinded and controlled clinical trials, for evaluating antidepressants in a real-world setting. The aim of the present study was to document the use of agomelatine in current medical practice and evaluate its effectiveness and safety in outpatients prescribed agomelatine to treat their current depressive episode. Methods This 12-month observational French study included patients initiating agomelatine treatment. The intensity and severity of depression were assessed using the 17-item Hamilton Depression Rating Scale (HAM-D17) total score and the Clinical Global Impression-Severity of Illness (CGI-S) scale. Patients’ quality of life and functioning were measured using the Quality of Life in Depression Scale and the Sheehan Disability Scale, respectively. The safety measures included emergent adverse events and biological samplings, with a focus on liver acceptability. Results A total of 1484 patients (70% of women; 49.6 ± 15.4 years of age) were enrolled in the study. Most patients (62.3%) were treated with agomelatine for at least 6 months and 28.8% were treated for at least 1 year. Mean HAM-D17 total score and mean CGI-S scores decreased by 13.6 ± 8.1 and 2.1 ± 1.5 points, respectively, from baseline to last visit on agomelatine. Rates of responders (i.e. with a decrease in HAM-D17 total score by at least 50%) and remitters (HAM-D total score < 7) at the last visit were 90.7% and 56.0%, respectively. The mean HAM-D total score decreased after agomelatine withdrawal (− 4.1 ± 6.7) until the last visit. The quality of life and daily functioning of patients improved, while the numbers of days lost and underproductive days decreased over the follow-up period. Safety findings were in accordance with the known information regarding agomelatine. Conclusion In the current medical practice, this study confirms the effectiveness and good tolerability of agomelatine administered for a treatment period in agreement with guideline recommendations. Trial registration number ISRCTN53570733 on 27 August 2010.
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Affiliation(s)
- Philip Gorwood
- Centre Hospitalier Sainte-Anne (GHU Paris Psychiatrie et Neurosciences), INSERM U1266 and Paris-Descartes University, Paris, France
| | - Jacques Benichou
- Centre Hospitalier Universitaire de Rouen, Unité de Biostatistiques, Rouen, France
| | - Nicolas Moore
- INSERM CIC1401, Université de Bordeaux, 33076, Bordeaux, France
| | - Marine Wattez
- Servier Affaires Médicales, 35 Rue de Verdun, 92284, Suresnes Cedex, France
| | - Marie-Cécile Secouard
- Institut de Recherches Internationales Servier (IRIS), 50 Rue Carnot, 92284, Suresnes Cedex, France
| | - Xavier Desobry
- Institut de Recherches Internationales Servier (IRIS), 50 Rue Carnot, 92284, Suresnes Cedex, France
| | - Françoise Picarel-Blanchot
- Servier Affaires Médicales, 35 Rue de Verdun, 92284, Suresnes Cedex, France.
- Institut de Recherches Internationales Servier (IRIS), 50 Rue Carnot, 92284, Suresnes Cedex, France.
| | - Christian de Bodinat
- Institut de Recherches Internationales Servier (IRIS), 50 Rue Carnot, 92284, Suresnes Cedex, France
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Bertschy G, Haffen E, Gervasoni N, Gex-Fabry M, Osiek C, Marra D, Aubry JM, Bondolfi G. Self-rated residual symptoms do not predict 1-year recurrence of depression. Eur Psychiatry 2020; 25:52-7. [DOI: 10.1016/j.eurpsy.2009.05.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2009] [Revised: 05/11/2009] [Accepted: 05/20/2009] [Indexed: 12/28/2022] Open
Abstract
AbstractBackgroundResidual depressive symptoms are generally documented as a risk factor for recurrence. In the absence of a specific instrument for the assessment of residual symptoms, a new 25-item Depression Residual Symptom Scale (DRSS) was elaborated and tested for recurrence prediction over a 1-year follow-up.Sampling and methodsFifty-nine patients in remission after a major depressive episode (MDE) were recruited in two centres. They were assessed with the DRSS and the Montgomery-Asberg Depression Rating Scale (MADRS) at inclusion and followed for 1 year according to a seminaturalistic design. The DRSS included specific depressive symptoms and subjective symptoms of vulnerability, lack of return to usual self and premorbid level of functioning.ResultsSeverity of residual symptoms was not significantly associated with increased risk of recurrence. However, DRSS score was significantly higher among patients with three or more episodes than one to two episodes. Number of previous episodes and treatment interruption were not identified as significant predictors of recurrence.ConclusionThe proposed instrument is not predictive of depressive recurrence, but is sensitive to increased perception of vulnerability associated with consecutive episodes. Limitations include small sample size, seminaturalistic design (no standardisation of treatment) and content of the instrument.
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Barriers to complete recovery of major depression: cross-sectional, multi-centre study on clinical practice. RECORD study. REVISTA DE PSIQUIATRIA Y SALUD MENTAL 2018; 12:141-150. [PMID: 30429067 DOI: 10.1016/j.rpsm.2018.10.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/12/2018] [Revised: 10/15/2018] [Accepted: 10/15/2018] [Indexed: 11/23/2022]
Abstract
INTRODUCTION To identify barriers to complete recovery in patients suffering from major depressive disorder. METHODS A total of 461 psychiatrists participated in a cross-sectional, non-randomised, qualitative and multi-centre study based on a survey. The study questionnaire included 42 ítems related to management, prevalence, patient profile, impact of residual symptoms, barriers to full recovery, and strategies to increase complete recovery. RESULTS Complete recovery was defined by 86% of participants as complete remission of symptoms plus functional recovery. A total of 83.4% of participants considered that sick leave usually lasted more than 4 months. Seventy-five percent stated that residual symptoms were the main reason for prolongation of sick leave, and 62% that between 26%-50% of patients complained of residual symptoms. Poor compliance with treatment was the most important barrier to complete recovery, followed by a lack of patient cooperation, late beginning of treatment, partial response to antidepressants, and low doses of antidepressant medication. In the case of partial response, 71.8% of participants chose to increase the dose of current treatment, and in the case of lack of response, 72.7% would switch to another antidepressant, and 22.8% would use the combination of two antidepressants, in which case 85.2% would choose agents with complementary mechanisms of action. Forty-nine percent of participants would recommend standard cognitive-behavioural psychotherapy for patients without complete response. CONCLUSIONS Some 50% of patients did not achieve complete remission, frequently related to persistence of residual symptoms. Achievement of complete recovery should be an essential objective.
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Park SA, Jeon SW, Yoon HK, Yoon SY, Shin C, Ko YH. Characteristics of Residual Symptoms in Korean Patients with Major Depressive Disorder: A Validation Study for the Korean Version of Depression Residual Symptom Scale. Psychiatry Investig 2018; 15:178-185. [PMID: 29475225 PMCID: PMC5900396 DOI: 10.30773/pi.2017.07.13] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2017] [Revised: 06/23/2017] [Accepted: 07/13/2017] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE Residual symptoms of depression are related to more severe and chronic course of functional impairment with higher risk of relapse. The objective of this study was to validate, and determine psychometric properties of the Korean version of Depression Residual Symptom Scale (KDRSS). METHODS A total of 203 outpatients with recent episode of major depression based on DSM-IV criteria were enrolled in this study. They had been treated with antidepressants and assessed by KDRSS, Hamilton Depression Rating Scale-24 (HDRS-24), and Montgomery-Åsberg Depression Rating Scale (MARDS). The validity and reliability of KDRSS were assessed, including internal consistency reliability, concurrent validity, temporal stability, factorial validity, and discriminative validity. RESULTS Internal consistency (Cronbach's alpha=0.961), concurrent validity (MADRS: r=0.731, p<0.01, HDRS-24: r=0.663, p<0.01), and temporal stability (r=0.726, p<0.01) of KDRSS were all excellent. KDRSS showed good discriminative validity based on MARDS. KDRSS consisted of one-factor structure accounting for 63.8% of total variance. All subjects except two in full remission group had one or more residual symptoms. In 7 subscales of KDRSS consisting of similar items respectively, 'lack of energy' was the most commonly reported, followed by 'increased emotionalism' in this group. CONCLUSION KDRSS is a useful and sensitive instrument for measuring residual depressive symptoms. Since some depressive symptoms including 'lack of energy' and 'increased emotionalism' in patients with full remission might be persistent during psychiatric intervention, these symptoms need to be focused on in clinical practice.
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Affiliation(s)
- Sol A Park
- Department of Psychiatry, Korea University College of Medicine, Ansan Hospital, Ansan, Republic of Korea
| | - Sang Won Jeon
- Department of Psychiatry, Sungkyunkwan University School of Medicine, Kangbuk Samsung Hospital, Seoul, Republic of Korea
| | - Ho-Kyoung Yoon
- Department of Psychiatry, Korea University College of Medicine, Ansan Hospital, Ansan, Republic of Korea
| | - Seo Young Yoon
- Department of Psychiatry, Catholic University of Daegu School of Medicine, Daegu, Republic of Korea
| | - Cheolmin Shin
- Department of Psychiatry, Korea University College of Medicine, Ansan Hospital, Ansan, Republic of Korea
| | - Young-Hoon Ko
- Department of Psychiatry, Korea University College of Medicine, Ansan Hospital, Ansan, Republic of Korea
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Gender differences in quality of life and functional disability for depression outpatients with or without residual symptoms after acute phase treatment in China. J Affect Disord 2017; 219:141-148. [PMID: 28550766 DOI: 10.1016/j.jad.2017.05.021] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2017] [Revised: 04/29/2017] [Accepted: 05/04/2017] [Indexed: 12/31/2022]
Abstract
BACKGROUND Depression is associated with substantial personal suffering and reduced quality of life and functioning. The aim of this study was to investigate gender differences on quality of life and functional impairment of outpatients with depression after acute phase treatment. METHODS 1503 depression outpatients were recruited from eleven hospitals in China. Subjects were evaluated with sociodemographic characteristics, history and self-report instruments, related to severity of symptoms, function and quality of life. All data were analyzed to determine the gender differences. RESULTS Men had a younger age at onset and the first onset age, higher education compared to women in total patients and with or without residual symptoms group. Using regression analysis, it was found that gender was significantly statistically related to severity scores of SDS and had no correlation with Q-LES-Q-SF total scores. In the residual symptoms group, greater functional impairment was noted by men in the area of work and social life. Significant gender differences of mood, work and sexual life in quality of life were observed. LIMITATIONS This is a cross-sectional study of depressed outpatients and duration of acute phase treatment may not an adequate time to measure changes. CONCLUSIONS Depression appears to affect men more seriously than women after acute phase treatment. Men had a younger age at onset and the first onset age, higher education, more functional impairment and lower satisfaction of quality of life in mood, work and sexual life. Gender differences affect acute treatment, remission and recovery.
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Ionescu DF, Rosenbaum JF, Alpert JE. Pharmacological approaches to the challenge of treatment-resistant depression. DIALOGUES IN CLINICAL NEUROSCIENCE 2016. [PMID: 26246787 PMCID: PMC4518696 DOI: 10.31887/dcns.2015.17.2/dionescu] [Citation(s) in RCA: 115] [Impact Index Per Article: 14.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Although monoaminergic antidepressants revolutionized the treatment of Major Depressive Disorder (MDD) over a half-century ago, approximately one third of depressed patients experience treatment-resistant depression (TRD). Such patients account for a disproportionately large burden of disease, as evidenced by increased disability, cost, human suffering, and suicide. This review addresses the definition, causes, evaluation, and treatment of unipolar TRD, as well as the major treatment strategies, including optimization, augmentation, combination, and switch therapies. Evidence for these options, as outlined in this review, is mainly focused on large-scale trials or meta-analyses. Finally, we briefly review emerging targets for antidepressant drug discovery and the novel effects of rapidly acting antidepressants, with a focus on ketamine.
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Affiliation(s)
- Dawn F Ionescu
- Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Jerrold F Rosenbaum
- Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Jonathan E Alpert
- Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts, USA
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Boerema AM, Cuijpers P, Beekman ATF, Hellenthal A, Voorrips L, van Straten A. Is duration of psychological treatment for depression related to return into treatment? Soc Psychiatry Psychiatr Epidemiol 2016; 51:1495-1507. [PMID: 27448572 PMCID: PMC5101270 DOI: 10.1007/s00127-016-1267-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2015] [Accepted: 07/15/2016] [Indexed: 11/30/2022]
Abstract
PURPOSE There is increasing pressure on mental health providers to reduce the duration of treatments, while retaining level of quality and effectiveness. The risk is that the population is underserved and therefore needs new treatment episodes. The primary aim of this study was to investigate whether duration of treatment and return into mental health care were related. METHODS This study examined Dutch patients with an initial treatment episode in 2009 or 2010 in specialized mental health settings for depressive disorder (N = 85,754). Follow-up data about treatment episodes were available up until 2013. The data set included demographic (age, gender), and clinical factors (comorbidity with other DSM-IV Axis; scores on the 'Global Assessment of Functioning'). Cox regression analyses were used to assess whether duration of treatment and relapse into mental health care were related. RESULTS The majority of patients did not return into mental health care (86 %). Patients with a shorter duration of treatment (5-250 min; 251-500 min and 751-1000 min) were slightly more likely to return (reference group: >1000 min) (HR 1.19 95 % CI 1.13-1.26; HR 1.11 95 % CI 1.06-1.17; HR 1.18 95 % CI 1.11-1.25), adjusted for demographic and clinical variables. CONCLUSIONS The results suggest that a longer duration of treatment may prevent return into mental health care in some groups. However, because of the design of the study, no causal inference can be drawn. Further research, preferably in a RCT, is needed to determine whether the trend towards lower intensity treatments is associated with repeated mental health care use.
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Affiliation(s)
- A M Boerema
- Department of Clinical Neuro and Developmental Psychology, Section Clinical Psychology, Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, van der Boechorststraat 1, 1081 BT, Amsterdam, The Netherlands.
- EMGO+ Institute for Health Care and Research, VU University Medical Centre, van der Boechorststraat 7, 1081 BT, Amsterdam, The Netherlands.
| | - P Cuijpers
- Department of Clinical Neuro and Developmental Psychology, Section Clinical Psychology, Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, van der Boechorststraat 1, 1081 BT, Amsterdam, The Netherlands
- EMGO+ Institute for Health Care and Research, VU University Medical Centre, van der Boechorststraat 7, 1081 BT, Amsterdam, The Netherlands
| | - A T F Beekman
- EMGO+ Institute for Health Care and Research, VU University Medical Centre, van der Boechorststraat 7, 1081 BT, Amsterdam, The Netherlands
- Department of Psychiatry, VU University Medical Centre, van der Boechorststraat 7, 1081 BT, Amsterdam, The Netherlands
| | - A Hellenthal
- Statistics Netherlands (CBS), Henri Faasdreef 312, 2492 JP, The Hague, The Netherlands
| | - L Voorrips
- Statistics Netherlands (CBS), Henri Faasdreef 312, 2492 JP, The Hague, The Netherlands
| | - A van Straten
- Department of Clinical Neuro and Developmental Psychology, Section Clinical Psychology, Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, van der Boechorststraat 1, 1081 BT, Amsterdam, The Netherlands
- EMGO+ Institute for Health Care and Research, VU University Medical Centre, van der Boechorststraat 7, 1081 BT, Amsterdam, The Netherlands
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Carvalho AF, Berk M, Hyphantis TN, McIntyre RS. The integrative management of treatment-resistant depression: a comprehensive review and perspectives. PSYCHOTHERAPY AND PSYCHOSOMATICS 2014; 83:70-88. [PMID: 24458008 DOI: 10.1159/000357500] [Citation(s) in RCA: 71] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/28/2013] [Accepted: 11/20/2013] [Indexed: 12/18/2022]
Abstract
BACKGROUND Major depressive disorder is a prevalent and disabling illness. Notwithstanding numerous advances in the pharmacological treatment of depression, approximately 70% of patients do not remit after first-line antidepressant treatment. METHODS The MEDLINE/PubMed, EMBASE and ClinicalTrials.gov electronic databases were searched from inception to October 1, 2013, for randomized controlled trials (RCT), relevant open-label trials, meta-analyses and ongoing trials of pharmacological and psychotherapeutic approaches to treatment-resistant depression (TRD). RESULTS Switching to a different antidepressant is a useful option following nonresponse to a first-line agent. Although widely used in clinical practice, there is limited evidence to support antidepressant combination for TRD. Notwithstanding evidence for lithium or T3 augmentation to be successful in TRD, most studies were carried out when participants were treated with tricyclic antidepressants (TCA). Of the available strategies to augment the response to new-generation antidepressants, the use of some atypical antipsychotics is best supported by evidence. Several novel therapeutic options are currently discussed. Evidence suggests that cognitive therapy (CT) is an effective strategy for TRD. CONCLUSIONS The success of switching to a different antidepressant following a first-line agent is supported by evidence, but there is limited evidence for effective combination strategies. Lithium and T3 augmentation of TCA have the strongest evidence base for successful treatment of TRD. The use of augmentation of newer-generation antidepressants with atypical antipsychotics is supported by a growing evidence base. Current evidence supports CT as an effective strategy for TRD. There is a need for additional large-scale RCT of TRD. The development of new antidepressants targeting novel pathways opens a promising perspective for the management of TRD.
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Affiliation(s)
- Andre F Carvalho
- Psychiatry Research Group, Department of Clinical Medicine, Faculty of Medicine, Federal University of Ceará, Fortaleza, Brazil
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Godard J, Baruch P, Grondin S, Lafleur MF. Psychosocial and neurocognitive functioning in unipolar and bipolar depression: a 12-month prospective study. Psychiatry Res 2012; 196:145-53. [PMID: 22370154 DOI: 10.1016/j.psychres.2011.09.013] [Citation(s) in RCA: 59] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2011] [Revised: 07/09/2011] [Accepted: 09/17/2011] [Indexed: 10/28/2022]
Abstract
Previous studies have revealed psychosocial and cognitive impairments in patients during unipolar and bipolar depression, which persist even in subsyndromal and euthymic states. Currently, little is known about the nature and the extent of psychosocial and cognitive deficits during depression. The aim of the present study was to characterize psychosocial and cognitive profiles among unipolar (MDD) and bipolar (BD) patients during a major depressive episode and to compare the profiles of the patient groups. Depressed patients with MDD (n=13) and BD (n=11) were followed over a period of 12 months. Clinical, psychosocial and neuropsychological assessments were conducted at baseline and at 6-week, 4-month, 8-month and 12-month follow-ups. In the case of severe mood disorders, psychosocial and neurocognitive functioning seem similar among MDD and BD patients during a depressive episode. All MDD and BD patients had global psychosocial dysfunction, characterized by occupational and relational impairments. Furthermore, the neurocognitive profile was heterogeneous with regard to the nature and extent of cognitive deficits but attentional processes were frequently compromised. After 1 year of treatment, occupational and relational impairments, as well as neurocognitive dysfunction, persisted sufficiently to alter daily functioning.
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Affiliation(s)
- Julie Godard
- Institut universitaire en santé mentale de Québec, Québec, Canada.
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Favré P. [Clinical efficacy and achievement of a complete remission in depression: increasing interest in treatment with escitalopram]. Encephale 2011; 38:86-96. [PMID: 22381728 DOI: 10.1016/j.encep.2011.11.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2011] [Accepted: 09/12/2011] [Indexed: 10/14/2022]
Abstract
Such a prevalent disease as Major Depressive Disorder (MDD), associated with prominent impairment in physical and social functioning, implies as well an increased morbidity and mortality. Long-term treatments are required due to the frequent occurrence of relapses. Patient compliance is a core factor in both acute and continuation treatment, closely related to tolerability issues. We have partially reviewed the literature published on PubMed since 2004 which assess the relative antidepressant efficacy of escitalopram and comparator antidepressants in adult patients who met DSM-IV criteria for major depressive disorder (MDD). Clinically important differences exist between commonly prescribed antidepressants. These analyses are in favor of a superior efficacy and tolerability of long-term escitalopram treatment (10 to 20mg/day) compared with active controls, including selective serotonin re-uptake inhibitors (SSRIs) (paroxetine, citalopram, bupropion, fluoxetine, fluvoxamine, sertraline), serotonin/noradrenaline reuptake inhibitors (SNRIs) (venlafaxine, milnacipran and duloxetine) and noradrenergic and specific serotonergic antidepressants (NaSSAs) (mirtazapine). Cipriani et al. (2009) have performed a network meta-analysis of 12 new generation antidepressants. They have shown that clinically important differences exist between commonly prescribed antidepressants for both efficacy and acceptability in favor of escitalopram and sertraline in acute treatment, defined as 8-week treatment. Kasper et al. (2009) conducted a post-hoc pooled analysis of data from two 6-month randomized controlled trials that revealed superior efficacy and tolerability of escitalopram when compared with paroxetine. The pooled analysis of four randomized, double-blind, active comparator, 6-month trials in MDD, by Wade et al. (2009), showed that short-term outcomes may predict long-term treatment compliance and outcomes. A higher probability of achieving remission was associated with responding after 8 weeks and with completing 6 months of treatment. Furthermore, Week 24 complete remission (MADRS≤5) was significantly (P<0,01) higher for escitalopram (51.7%) than for the pooled comparators (45.6%). And after 6 months, fewer patients discontinued treatment with escitalopram (15.9%) than with the pooled comparators (23.9%) (P<0.001). This fragmentary review of the literature shows that it is necessary to adopt a stringent definition of remission in depression, especially in clinical trials; a MADRS total score less or equal to 10 to define remission, a MADRS total score less or equal to 5 to define complete remission, and moreover no MADRS single item greater than 1 to define symptom-free remission. In all these meta-analyses, the superiority of escitalopram compared with other antidepressants was confirmed for both acute and long-term treatment of MDD, especially in harshly depressed patients.
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Affiliation(s)
- P Favré
- EPS Ville-Evrard, secrétariat 93G16, 202, avenue J.-Jaurès, 93332 Neuilly-sur-Marne cedex, France.
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Roca M, García-Toro M, García-Campayo J, Vives M, Armengol S, García-García M, Asensio D, Gili M. Clinical differences between early and late remission in depressive patients. J Affect Disord 2011; 134:235-41. [PMID: 21676465 DOI: 10.1016/j.jad.2011.05.051] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2011] [Revised: 05/25/2011] [Accepted: 05/26/2011] [Indexed: 11/27/2022]
Abstract
OBJECTIVE Predicting treatment outcome at an early stage is clinically relevant. The main objectives are: to compare rates of remission after acute and continuation phase treatment and to determine the most common residual symptoms among remitted patients; to compare the residual symptoms in early and late remitted and to identify factors that predict early or faster remission. METHOD It is a prospective, naturalistic, multicenter, and nationwide epidemiological study of 1595 depressive outpatients. Severity of depressive symptoms was assessed with the Hamilton Depression Rating Scale (HDRS) and the Self Rated Inventory of Depressive Symptomatology (IDS-SR(30)). Assessments were carried out after 6-8 weeks of antidepressant treatment and after 14-20 weeks of continuation treatment. Early remitters were defined with an IDS-SR(30) score ≤ 14 at first and second assessment. Late remitters were defined as those scoring IDS-SR(30) >14 at first and IDS-SR(30) score ≤ 14 at second assessment. RESULTS 140 subjects (8.8%) were in remission after 6-8 weeks of antidepressant treatment and 862 remitted (59%) after 16-20 weeks of treatment. The mean number of residual symptoms is significantly higher among patients who remit later. Greater differences between early and late remitters were found in the following symptoms: feeling sad, reactivity of mood, interpersonal sensitivity and pleasure/enjoyment. Multivariate analysis showed that only comorbid anxiety disorder is significantly associated with late remission. CONCLUSIONS Early remitted patients have a better "quality" of remission. Late remission is associated with residual symptoms more related to core depressive symptoms. Residual symptoms in early remitted patients may constitute a new target for the treatment of depression.
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Affiliation(s)
- Miquel Roca
- Institut Universitari d'Investigació en Ciències de la Salut, University of Balearic Islands, Palma de Mallorca, Spain.
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The Impact of Residual Symptoms in Major Depression. Pharmaceuticals (Basel) 2010; 3:2426-2440. [PMID: 27713362 PMCID: PMC4033933 DOI: 10.3390/ph3082426] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2010] [Revised: 07/02/2010] [Accepted: 07/22/2010] [Indexed: 12/28/2022] Open
Abstract
The current definition of remission from major depressive disorder does not fully take into account all aspects of patient recovery. Residual symptoms of depression are very common in patients who are classified as being in remission. Patients with residual symptoms are at increased risk of functional and interpersonal impairments, and are at high risk for recurrence of depression. This article discusses the incidence of residual symptoms of depression, as well as the risks and consequences of these symptoms, and will review the state of current treatment.
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Abstract
This review paper deals with the question of the relationships between clinical severity of depression, recurrence risk and chronicity risk. About 60% of the subjects with a first episode of major depression will present a second episode lifetime. The risk of recurrence increases slightly with the severity of the index episode. Conversely, depression severity tends to be slightly higher in recurrent episodes as compared with first episodes. This is supported by a few studies of consecutive episodes within the same patients but it could also result from a selection effect. The risk that a depressive episode is still meeting the criteria of a major depressive episode two years after onset is between 10 and 20%. Neither the severity of the index episode nor its recurrent character clearly increases the risk of its chronic evolution. Finally, minor depression (as a dysthymic disorder or residual symptoms) increases the risk of a new major depressive episode. We may conclude that there are only moderate interactions between the clinical severity of depression and the risks of chronicity and recurrence. Worsening of one of these three variables will not result into a dramatic worsening of the two others. In fact, chronicity and recurrence do not specifically contribute to the severity of the next episode, they only contribute to the long-term severity of depressive disorders, which is already by itself a major issue.
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Affiliation(s)
- G Bertschy
- Hôpitaux universitaires et Université de Strasbourg, Service de psychiatrie 2, Hôpital civil, 1 place de l'Hôpital, 67091 Strasbourg cedex.
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Kasper S, Baldwin DS, Larsson Lönn S, Boulenger JP. Superiority of escitalopram to paroxetine in the treatment of depression. Eur Neuropsychopharmacol 2009; 19:229-37. [PMID: 19185467 DOI: 10.1016/j.euroneuro.2008.12.003] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2008] [Revised: 12/01/2008] [Accepted: 12/09/2008] [Indexed: 01/01/2023]
Abstract
Post-hoc pooled analysis of data from two 6-month randomised controlled trials in patients with major depressive disorder (MDD) revealed superior efficacy and tolerability of escitalopram when compared with paroxetine. Escitalopram (n=394) produced a significantly (p<0.01) greater mean treatment difference of 2.0 points in primary endpoints, judged using the Montgomery-Asberg Depression Rating Scale (MADRS) total score, compared with paroxetine (n=383). Significant differences were also observed in Clinical Global Impression (CGI)--severity (escitalopram, 2.1; paroxetine, 2.4; p<0.01) and CGI--improvement (escitalopram, 1.8; paroxetine, 2.0: p<0.01). In the sub-group of severely depressed patients (baseline MADRS> or = 30), escitalopram showed further improved efficacy compared with paroxetine in all scores. This analysis supports previous observations of superior efficacy and tolerability of long-term escitalopram treatment (10 to 20 mg/day) compared with paroxetine (20 to 40 mg/day). Escitalopram is a good therapeutic option for the long-term treatment of MDD, particularly in severely depressed patients.
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Affiliation(s)
- Siegfried Kasper
- Department of Psychiatry and Psychotherapy, Medical University of Vienna, Austria.
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Johnson DA, Ingram CD, Grant EJ, Craighead M, Gartside SE. Glucocorticoid receptor antagonism augments fluoxetine-induced downregulation of the 5-HT transporter. Neuropsychopharmacology 2009; 34:399-409. [PMID: 18496518 DOI: 10.1038/npp.2008.70] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
The effects of combined treatment with a glucocorticoid receptor (GR) antagonist, Org 34850, and a selective serotonin reuptake inhibitor (SSRI), fluoxetine, were investigated on pre- and postsynaptic aspects of 5-HT neurotransmission. Rats were treated for 14 days with Org 34850 (15 mg per kg per day subcutaneously), fluoxetine (10 mg per kg per day intraperitoneally), or a combination of both drugs. [(3)H]-citalopram binding (an index of 5-HT transporter (5-HTT) expression) was only slightly affected by Org 34850 alone: decreased in cortex and midbrain and increased in hippocampus. In contrast, chronic fluoxetine markedly decreased 5-HTT levels in all regions. Importantly, this decrease was significantly enhanced by combined Org 34850/fluoxetine treatment. There were no changes in the expression of 5-HTT mRNA, suggesting these effects were not due to changes in gene transcription. Expression of tryptophan hydroxylase mRNA and both 5-HT(1A) autoreceptor mRNA and protein (assessed using [(3)H]-8-OH-DPAT binding) were unchanged by any treatment. The expression of postsynaptic 5-HT(1A) receptor protein in the forebrain was unaltered by fluoxetine, Org 34850 or the combined Org 34850/fluoxetine treatment. This downregulation of 5-HTT by fluoxetine and its enhancement by Org 34850 can explain our recent observation that GR antagonists augment the SSRI-induced increase in extracellular 5-HT. In addition, these data suggest that the augmentation of forebrain 5-HT does not result in downregulation of forebrain 5-HT(1A) receptor expression. Given the importance of 5-HT(1A) receptor-mediated transmission in the forebrain to the antidepressant response, these data indicate that co-administration of GR antagonists may be effective in augmenting the antidepressant response to SSRI treatment.
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Affiliation(s)
- Daniel Anthony Johnson
- Institute of Neuroscience, The Medical School, Newcastle University, Newcastle upon Tyne, UK
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Pelissolo A. [Depression and pain: prevalence and clinical implication]. Presse Med 2008; 38:385-91. [PMID: 18977630 DOI: 10.1016/j.lpm.2008.06.022] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2008] [Revised: 05/23/2008] [Accepted: 06/04/2008] [Indexed: 10/21/2022] Open
Abstract
Somatic pains are frequent in patients with major depression. Although they are not included in classical symptoms of depression, physical pains are found in 50-90% of depressed patient. They are more frequent in severe depressions, and especially in psychiatric inpatients with depression. Physical painful symptoms are good indices of depression severity and namely are predictive of poorer responses to treatments, and then of elevated rates of relapse when pains are persistent as residual symptoms after remission of the episode. More frequent pains in depressive patients are headaches, limb, back and joint pains. Aetiological hypothesis to explain the coexistence of physical pains and depression are based on the well-known dysfunction of the serotonergic and noradrenergic pathways in depression, which explains mood symptoms but also a lack of inhibitory control of ascending pain messages, normally controlled in spinal cord by descending serotonergic and noradrenergic projections. This phenomenon could explain the development of an interoceptive painful hypersensitivity, without external sensitivity. Antidepressants with dual serotonergic and noradrenergic actions are efficacious to treat chronic pains, for example in diabetic neuropathy. In line with monoaminergic hypotheses shown above, this is in favour of the use of these serotonin and norepinephrine reuptake inhibitors in depression with important physical pains, but this issue needs further confirmation studies.
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Affiliation(s)
- Antoine Pelissolo
- Service de Psychiatrie Adulte, CNRS UMR 7593, Hôpital Pitié-Salpêtrière, AP-HP, Paris, France.
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Viinamäki H, Hintikka J, Tolmunen T, Honkalampi K, Haatainen K, Koivumaa-Honkanen H. Partial remission indicates poor functioning and a high level of psychiatric symptoms: a 3-phase 6-year follow-up study on major depression. Nord J Psychiatry 2008; 62:437-43. [PMID: 18836926 DOI: 10.1080/08039480801959281] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Patients with depression in partial remission are at high risk of relapse, but factors associated with being in this outcome group are not well known. We conducted a clinical survey to examine the course of major depression in 87 patients during a follow-up period of 6 years. Beck Depression Inventory (BDI) scores indicated the outcome of depression, i.e. remission, partial remission or fully symptomatic, at 6, 12 and 24 months and after 6 years. The prevalence of partial remission varied from 16% to 23% at different follow-ups. All symptom and functioning scale scores indicated at every assessment that the partial depression group managed better than those in the fully symptomatic group, but worse than those in remission. Partial remission was associated with a significant impairment in psychosocial functioning and a high level of symptoms throughout the follow-up. The partial remission group must be recognized and actively treated.
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Affiliation(s)
- Heimo Viinamäki
- Department of Psychiatry, Kuopio University Hospital and University of Kuopio, Kuopio, Finland.
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Johnson DA, Grant EJ, Ingram CD, Gartside SE. Glucocorticoid receptor antagonists hasten and augment neurochemical responses to a selective serotonin reuptake inhibitor antidepressant. Biol Psychiatry 2007; 62:1228-35. [PMID: 17651703 DOI: 10.1016/j.biopsych.2007.05.003] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2007] [Revised: 04/19/2007] [Accepted: 05/02/2007] [Indexed: 11/24/2022]
Abstract
BACKGROUND Selective serotonin reuptake inhibitor (SSRI) antidepressant drugs have a delayed onset and commonly produce an incomplete therapeutic response. The therapeutic actions of SSRIs are thought to depend on increased forebrain extracellular serotonin (5-HT), after desensitization of somatodendritic 5-HT(1A) autoreceptors. Here we determined whether concurrent glucocorticoid receptor (GR) blockade enhances these neurochemical responses to the SSRI fluoxetine. METHODS Male rats were treated (3, 7, or 14 days) with either fluoxetine (10 mg/kg IP) or vehicle once daily, in combination with either a GR antagonist (Org 34850 15 mg/kg SC or Org 34517 25 mg/kg SC) or vehicle twice daily. After treatment, 5-HT in the medial prefrontal cortex was measured by microdialysis. RESULTS Chronic fluoxetine treatment (14 days) raised basal 5-HT and also attenuated the fall in 5-HT after acute systemic administration of fluoxetine (10 mg/kg IP), indicating desensitization of 5-HT(1A) autoreceptors. Concurrent chronic administration (14 days) of Org 34850 or Org 34517 enhanced the fluoxetine-induced increase in basal 5-HT. Org 34850 also hastened the 5-HT(1A) autoreceptor desensitization induced by chronic fluoxetine treatment. Org 34850 alone (14 days) failed to alter basal 5-HT or 5-HT(1A) autoreceptor desensitization. CONCLUSIONS Antidepressant response is proposed to depend on 5-HT(1A) autoreceptor desensitization and elevation of forebrain 5-HT. These data suggest adjunctive GR antagonists might both hasten and enhance antidepressant responses to SSRIs.
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Affiliation(s)
- Daniel A Johnson
- Psychobiology Research Group, School of Neurology, Neurobiology and Psychiatry, Newcastle University, Newcastle upon Tyne, United Kingdom
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Dombrovski AY, Mulsant BH, Houck PR, Mazumdar S, Lenze EJ, Andreescu C, Cyranowski JM, Reynolds CF. Residual symptoms and recurrence during maintenance treatment of late-life depression. J Affect Disord 2007; 103:77-82. [PMID: 17321595 PMCID: PMC2680091 DOI: 10.1016/j.jad.2007.01.020] [Citation(s) in RCA: 103] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2006] [Revised: 12/07/2006] [Accepted: 01/04/2007] [Indexed: 10/23/2022]
Abstract
BACKGROUND Many older patients who recover from an episode of major depression continue to suffer from depressed mood, anxiety, and sleep problems. Our study assesses the impact of these residual symptoms on the risk of recurrence during maintenance treatment of late-life depression. METHOD We analyzed data from a randomized clinical trial of maintenance treatment in patients with unipolar depression aged > or =70, 116 of whom remitted and remained stable during open pharmacotherapy and interpersonal psychotherapy (IPT) and were randomized to clinical management/pharmacotherapy; clinical management/placebo; monthly maintenance IPT/ pharmacotherapy; or monthly maintenance IPT/placebo. We assessed the impact of overall residual symptoms (based on the Hamilton Depression Rating Scale (HAM-D) total score) and of specific residual symptom clusters - mood symptoms (depressed mood, guilt, suicidality, energy/interests), sleep disturbance (early, middle, late insomnia), and anxiety (agitation, psychic and somatic anxiety, hypochondriasis) measured at randomization. Sleep disturbance was also assessed with the Pittsburgh Sleep Quality Index (PSQI). We used Cox proportional hazards regression models controlling for assignment to antidepressant medication versus placebo to identify predictors of recurrence. RESULTS Residual anxiety and residual sleep disturbance (as measured by the PSQI but not the HAM-D) independently predicted early recurrence. LIMITATIONS Use of HAM-D clusters to define residual symptoms; analysis limited to completers of acute and continuation treatment. CONCLUSIONS In patients with late-life depression who have remitted with pharmacotherapy and psychotherapy, the deleterious effect of residual symptoms is due to persisting anxiety and, possibly, residual sleep disturbance.
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Affiliation(s)
- Alexandre Y. Dombrovski
- Western Psychiatric Institute and Clinic, Department of Psychiatry, University of Pittsburgh School of Medicine
| | - Benoit H. Mulsant
- Western Psychiatric Institute and Clinic, Department of Psychiatry, University of Pittsburgh School of Medicine
- Centre for Addictions and Mental Health, and Department of Psychiatry, University of Toronto
| | - Patricia R. Houck
- Western Psychiatric Institute and Clinic, Department of Psychiatry, University of Pittsburgh School of Medicine
| | - Sati Mazumdar
- Department of Biostatistics, Graduate School of Public Health, University of Pittsburgh
| | - Eric J. Lenze
- Western Psychiatric Institute and Clinic, Department of Psychiatry, University of Pittsburgh School of Medicine
| | - Carmen Andreescu
- Western Psychiatric Institute and Clinic, Department of Psychiatry, University of Pittsburgh School of Medicine
| | - Jill M. Cyranowski
- Western Psychiatric Institute and Clinic, Department of Psychiatry, University of Pittsburgh School of Medicine
| | - Charles F. Reynolds
- Western Psychiatric Institute and Clinic, Department of Psychiatry, University of Pittsburgh School of Medicine
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Abstract
Depression is a serious illness associated with morbidity and mortality, but it is treatable. However, outcomes are often far from ideal with patients left with residual symptoms of depression. These are associated with poor social functioning and an increased risk of relapse.
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Affiliation(s)
- Ciaran Corcoran
- Clinical Psychopharmacology and Honorary Consultant Psychiatrist, School of Neurology, Neurobiology and Psychiatry, Royal Victoria Infirmary, Newcastle upon Tyne
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Boulenger JP, Huusom AKT, Florea I, Baekdal T, Sarchiapone M. A comparative study of the efficacy of long-term treatment with escitalopram and paroxetine in severely depressed patients. Curr Med Res Opin 2006; 22:1331-41. [PMID: 16834832 DOI: 10.1185/030079906x115513] [Citation(s) in RCA: 81] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVE This randomised, double-blind, fixed-dose study evaluated the efficacy of escitalopram and paroxetine in the long-term treatment of severely depressed patients with major depressive disorder (MDD). RESEARCH DESIGN AND METHODS Patients with a primary diagnosis of MDD and baseline Montgomery-Asberg Depression Rating Scale (MADRS) >or= 30 were randomised to 24 weeks of double-blind treatment with fixed doses of either escitalopram (20 mg) (n = 232) or paroxetine (40 mg) (n = 227). The primary analysis of efficacy was an analysis of covariance (ANCOVA) of change from baseline to endpoint (Week 24) in MADRS total score (last observation carried forward, LOCF). MAIN OUTCOME MEASURES; RESULTS At endpoint (24 weeks), the mean change from baseline in MADRS total score was -25.2 for patients treated with escitalopram (n = 228) and -23.1 for patients with paroxetine (n = 223), resulting in a difference of 2.1 points (p < 0.05). The difference in the change in the MADRS total score (LOCF) was significantly in favour of escitalopram from Week 8 onwards. The proportion of remitters (MADRS <or= 12) after 24 weeks was 75% for escitalopram and 67% for paroxetine (p < 0.05). The results on the primary efficacy scale were supported by significantly greater differences in favour of escitalopram on the Hamilton Anxiety, Hamilton Depression and Clinical Global Impression-Improvement and -Severity scales. For very severely depressed patients (baseline MADRS >or= 35), there was a difference of 3.4 points at endpoint in the MADRS total score in favour of escitalopram (p < 0.05). The overall withdrawal rate for patients treated with escitalopram (19%) was significantly lower than with paroxetine (32%) (p < 0.01). The withdrawal rate due to adverse events was significantly lower for escitalopram (8%) compared to paroxetine (16%) (p < 0.05). There were no significant differences in the incidence of individual adverse events during treatment. CONCLUSION Escitalopram is significantly more effective than paroxetine in the long-term treatment of severely depressed patients.
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Affiliation(s)
- J-P Boulenger
- University Department of Adult Psychiatry, CHU de Montpellier and INSERM E361, France.
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