DOES INTOLERANCE OR LACK OF RESPONSE WITH FLUOXETINE PREDICT THE SAMEWILL HAPPEN WITH SERTRALINE

Background: The purpose of this study was to determine whether sertral ine would be well tolerated and effective in patients who had failed f luoxetine therapy or were unable to tolerate the medication. Method: H ospital records were reviewed for 88 consecutive patients started on s ertraline treatment at McLean Hospital from February 11, 1992, to Augu st 28, 1992. Forty-two patients were identified who had received sertr aline treatment and who had had previous trials of fluoxetine. Patient s were contacted after discharge to determine sertraline efficacy and side effects. A variety of patient characteristics and outcome measure s were compared. Results: Thirty-nine subjects (93%) were available fo r follow-up interviews. The DSM-III-R diagnoses at discharge were as f ollows: major depression (N = 25), bipolar depression (N = 6), schizoa ffective disorder (N = 4), and obsessive-compulsive disorder (N = 4), The sertraline discontinuation rate was 64% (25/39) by a mean +/- SD o f 2.3 +/- 2.1 months. In patients with major depression (N = 25) and b ipolar depression (N = 6) discharged on sertraline, only 13 (42%) were considered responders to sertraline therapy, and at follow-up, only 8 (26%) of 31 were considered responders to sertraline therapy. Patient s who had previously discontinued fluoxetine because of side effects w ere significantly more likely to have side effects during sertraline t reatment (p = .027), and to have discontinued sertraline at follow-up (p = .018). Conclusion: Sertraline was found to be modestly efficaciou s and associated with numerous side effects and discontinuation rates in patients who had previously discontinued fluoxetine.