FLUOXETINE TREATMENT OF PATIENTS WITH MAJOR DEPRESSIVE DISORDER WHO FAILED INITIAL TREATMENT WITH SERTRALINE

Background: This study was conducted to determine if patients with maj or depressive disorder who had previously failed treatment with one se rotonin selective reuptake inhibitor (SSRI) would respond to a differe nt SSRI. Method: Adult outpatients (N = 106) with DSM-III-R major depr essive disorder and a history of either intolerance (N = 34) or nonres ponse (N = 72) to treatment with sertraline were treated with fluoxeti ne (mean dose = 37.2 mg/day) in a standardized, open-label, 6-week cli nical trial. Outcome was assessed at each visit using the Hamilton Rat ing Scale for Depression (HAM-D), the Clinical Global Impressions (CGI -Improvement and CGI-Severity) scales, and the Patient's Global Improv ement (PGI) scale, Results: Ninety-one patients (86%) completed the st udy, Sixty-seven patients (63%) responded to fluoxetine (i.e., experie nced greater than or equal to 50% reduction in HAM-D-28 total score at endpoint versus baseline). In addition, clinically and statistically significant improvements were noted on all measures of depressive symp toms and global functioning, There was a nonsignificant trend for pati ents with a history of less vigorous sertraline trials to respond more favorably to fluoxetine. Fluoxetine therapy was generally well tolera ted, and there were only slight differences in adverse events reported by patients who had been intolerant to sertraline versus those who we re nonresponders. Conclusion: These findings indicate that fluoxetine and sertraline, two widely used SSRIs, are not interchangeable. Patien ts who either have had trouble tolerating or have not responded to ser traline may do well on fluoxetine treatment.