VENLAFAXINE IN DYSTHYMIC DISORDER

Background: Dysthymic disorder is a chronic depression that is usually characterized by depression rating scale scores that are lower than t hose for major depressive disorder. Recent studies suggest that pharma cotherapy is quite effective in the treatment of patients with this co ndition and, in particular, that the newer antidepressants may be bett er tolerated than older tricyclic antidepressants. The purpose of this study was to investigate the use of a structurally novel antidepressa nt, venlafaxine, in the treatment of dysthymic disorder.Method: Sevent een patients with dysthymic disorder were entered into the study, and 14 completed it. A psychiatric interview was used to establish diagnos is, and behavior was assessed by using the Hamilton Rating Scale for D epression (HAM-D) and the Beck Depression Inventory (BDI). Patients we re seen over a 9-week period, and venlafaxine treatment proceeded on a n open-label basis, from a starting dose of 18.75 mg b.i.d. to a maxim um dose of 225 mg/day. Results: Two patients discontinued early becaus e of side effects; and 1 patient took a single dose, felt better, and did not complete the trial. Analyses of all 17 patients showed signifi cant improvement in HAM-D and BDI scores at the end of the study. Amon g the completers, there were two response patterns: one group of 7 pat ients responded quickly to low-dose (75 mg) venlafaxine, and a second group of 7 required the maximum dose. Three of the 7 high-dose patient s showed considerable improvement. Side effects in this study were gen erally in keeping with what has been reported using venlafaxine in tre atment of major depressive disorder. No patients evidenced increased b lood pressure. Conclusion: Our study supports the treatment of dysthym ic patients with venlafaxine, which has equal efficacy and greater tol erability than tricyclic antidepressants.