ABSTRACT
BACKGROUND: The purpose of this study was to study hopelessness as a predictor of response to fluoxetine in outpatients with Major Depressive Disorder (MDD). METHODS: The degree of hopelessness was assessed during the baseline visit with the use of the Beck Hopelessness Scale (BHS) in 312 patients with MDD (56.1% women; 39.8 +/- 10.3 years of age) who entered an 8-week, 20-mg, fixed-dose, open trial of fluoxetine. With the use of a logistic regression we tested whether BHS scores at baseline predicted clinical response, controlling for the severity of depression as reflected by the total score on the 17-item Hamilton Depression Rating Scale (HAM-D-17). With the use of a multiple regression we also tested whether BHS scores at baseline predicted HAM-D-17 scores at endpoint, controlling for HAM-D-17 scores at baseline. RESULTS: After controlling for depression severity at baseline, a greater degree of hopelessness was found to significantly increase the risk of non-response to fluoxetine (p = 0.0413), as well as the risk of greater endpoint depression severity (p = 0.0305). CONCLUSIONS: Hopelessness appeared to be associated with poorer response to treatment with fluoxetine in MDD, and this was independent of depression severity. Similar studies involving treatment with higher doses of fluoxetine and for greater duration as well as a placebo comparator arm are needed to further explore the relationship between hopelessness, placebo response and drug response.
Subject(s)
Antidepressive Agents, Second-Generation/therapeutic use , Depressive Disorder, Major/drug therapy , Fluoxetine/therapeutic use , Motivation , Adult , Antidepressive Agents, Second-Generation/adverse effects , Depressive Disorder, Major/diagnosis , Depressive Disorder, Major/psychology , Female , Fluoxetine/adverse effects , Humans , Male , Middle Aged , Personality Inventory/statistics & numerical data , Psychometrics , Statistics as Topic , Treatment FailureABSTRACT
Our objective was to assess the effectiveness and safety of the combination of duloxetine and bupropion for treatment-resistant major depressive disorder (TRD). A retrospective chart review was conducted to identify patients with major depressive disorder (MDD) who had not experienced full remission of symptoms following an adequate trial of either duloxetine (n = 3) or bupropion (n = 7), and who then received the combination of these two antidepressants for TRD. Ten patients [37.2 +/- 11.3 years of age, five women, baseline Clinical Global Impressions (CGI) scale score 4.4 +/- 1.1], seven of whom had not remitted following treatment with bupropion (330 +/- 67 mg, 20.5 +/- 12.2 weeks), and three of whom had not remitted following treatment with duloxetine (90 +/- 30 mg, 18 +/- 2 weeks) received at least 4 weeks of combination treatment. The CGI was administered when the combination was first prescribed, and following 8.8 +/- 4.0 (range, 4-16) weeks of treatment. There was a significant decrease in CGI-S (Severity) scores (4.4 +/- 1.1 to 2.1+/-0.9, P <.0001) following combination treatment. Three (30%) patients were remitters at follow-up, and six (60%) were responders who did not achieve full symptom remission. The mean maximum adjunctive duloxetine and bupropion doses were 60.0 +/- 17.3 mg and 175.0 +/- 114.5 mg, respectively. Side effects reported during combination treatment were nausea (n = 2), dry mouth (n = 2), jitteriness/agitation (n = 2), fatigue/drowsiness (n = 2), increased blood pressure (n = 1), increased sweating (n = 1), insomnia (n = 1), pruritus (n = 1), headache (n = 1), sexual dysfunction (n = 1), and weight gain (n = 1). Although preliminary, these results suggest a possible role for the combination of duloxetine and bupropion for TRD.
