Prophylactic efficacy of fluoxetine, escitalopram, sertraline, paroxetine, and concomitant psychotherapy in major depressive disorder: outcome after long-term follow-up.

Abstract

The acute efficacy of selective serotonin reuptake inhibitors (SSRIs) in the treatment of major depressive disorder (MDD) is well established; however their role in longer-term prevention of recurrence remains unconfirmed. This study aims at examining: the prophylactic efficacy of four commonly used SSRIs in MDD in a naturalistic setting with long-term follow-up, the effect of concomitant cognitive behavioral therapy (CBT), and the predictors of outcome. In a prospective cohort study, 387 patients who either remitted or responded following treatment with four different SSRIs-fluoxetine, escitalopram, sertraline and paroxetine-were followed up over several years. During an average follow-up period of 34.5 months, 76.5% of patients experienced MDD recurrence. Escitalopram and fluoxetine showed a numerically higher prophylactic efficacy than paroxetine and sertraline but the difference was statistically insignificant. The prophylactic efficacy for SSRI-only treatment was limited, with a recurrence rate of 82.0%, compared to 59.0% of patient recurrence rate in concomitant Cognitive Behavioral Therapy (CBT). The relatively small size of the CBT group and the lack of randomization may undermine the extrapolation of its findings to clinical practice. Nevertheless, the study preliminary data may help in defining the clinical utility of antidepressants and CBT in the prophylaxis from MDD recurrence.

• Authors: Eric D Peselow, Gabriel Tobia, Reneh Karamians, Demetria Pizano, Waguih William IsHak
• Journal: Psychiatry research (Psychiatry Res) Vol. 225 Issue 3 Pg. 680-6 (Feb 28 2015) ISSN: 1872-7123 [Electronic] Ireland
• PMID: 25496869 (Publication Type: Comparative Study, Journal Article)
• Copyright: Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

Chemical References

• Serotonin Uptake Inhibitors
• Fluoxetine
• Citalopram
• Paroxetine
• Sertraline

Topics

• Adult
• Citalopram (therapeutic use)
• Cognitive Behavioral Therapy
• Cohort Studies
• Combined Modality Therapy
• Depressive Disorder, Major (diagnosis, psychology, therapy)
• Female
• Fluoxetine (therapeutic use)
• Follow-Up Studies
• Humans
• Long-Term Care
• Male
• Middle Aged
• Paroxetine (therapeutic use)
• Prospective Studies
• Recurrence
• Selective Serotonin Reuptake Inhibitors (therapeutic use)
• Sertraline (therapeutic use)
• Treatment Outcome