ONSET OF IMPROVEMENT UNDER FLUOXETINE AND MOCLOBEMIDE

In a meta-analysis of the selective serotonin reuptake inhibitor fluox etine (n = 440) and the reversible and selective monoamine oxidase-A i nhibitor moclobemide (n = 437) we investigated the time course of impr ovement over 6 weeks for these two classes of anti depressants. Two di fferent methods of approach were applied: ii repeated measurement anal ysis of variance in combination with regression analysis, and (2) a su rvival-analytical approach that allowed us to determine onset of impro vement for the individual patient, to distinguish between early and la te improvers, to assess the predictive Value of early improvement: and to adequately process premature withdrawals. The two antidepressants of large biochemical and pharmacological differences yielded Virtually identical response-and drop-out rates, and exhibited no difference wi th respect to the time course of improvement. Onset of improvement occ urred in more than half of the patients within the first 2 weeks of tr eatment, and early improvement was highly predictive of later outcome. In particular, there was no indication for a delayed onset of action of antidepressants. Wt suggest that future studies should be standardi sed with respect to washout period and sufficiently dense assessments during the first 2 weeks of trial. Thus, patient samples can be subdiv ided reproducibly into early-, late-, partial-and non-remitters. This, in turn, may help to identify ''true'' drug responders, and to discov er why in some patients recovers becomes ''stuck'', Data already held by the pharmaceutical companies should be reanalysed in this respect. (C) 1998 Elsevier, Paris.