Treatment of major depression and anxiety with the selective serotonin re-uptake enhancer tianeptine in the outpatient psychiatric care setting of India.

ABSTRACT

In the outpatient psychiatric care setting, patients with major depression and anxiety comply poorly with traditional tricyclic antidepressants and specific serotonin re-uptake inhibitor treatment. The purpose of this study was to examine whether the low drop out rate reported with tianeptine in randomised studies is also reflected in daily outpatient psychiatric practice. In a six-week prospective multicentre study, treatment with tianeptine (12.5mg thrice daily) in 314 patients with major depression and anxiety, drawn from 25 randomly selected outpatient psychiatric practices across India was assessed. Outcome measures were frequency of drop outs due to side-effects and change in depression and anxiety rating scale scores. Intention to treat analysis showed that 7 patients (2.3%) discontinued treatment due to side-effects. Patients with an improvement of at least 50% from baseline on Montgomery Asberg Depression Rating Scale (MADRS) increased from 18.5% at week 3 to 53.0% at week 6; on the Hamilton Anxiety Rating Scale (HARS), patient responders likewise increased from 22.6% at three weeks to 52.2% at six weeks. When used in the setting of day to day outpatient psychiatric practice, tianeptine is a well-tolerated and effective antidepressant. It could serve as a useful alternative, and improve the present low compliance with treatment in patients with major depression and anxiety.