Inpharma 1531 - 1 Apr 2006

If at first you don’t succeed with anSSRI . . .

According to three subanalyses of the STAR*D* trial,augmenting or switching ineffective or intolerablecitalopram therapy with other antidepressants can bebeneficial for patients with depression,1,2 and positivematernal outcomes correlate with reduced rates of childpsychiatric diagnoses.3

4041 patients with depression were enrolled in level 1of the STAR*D trial and received treatment withcitalopram. Of these, 1439 did not achieve remission**

or did not tolerate citalopram and agreed to enter level 2of the study, in which patients could opt to augment orswitch their treatments to involve other SSRIs orcognitive therapy.1,2

. . . try adding a little something extra . . .565 patients opted to augment their citalopram

therapy with another antidepressant and wererandomised to additional treatment with sustained-release (SR) bupropion ≤ 400 mg/day (n = 279) orbuspirone ≤ 60 mg/day, for up to 14 weeks.1 At studyend, rates of remission were comparable between thecitalopram plus bupropion SR and citalopram plusbuspirone groups (29.7% vs 30.1%, respectively).

. . . or try something a little different . . .727 patients opted to switch from citalopram to

another antidepressant and were subsequentlyrandomised to receive bupropion SR ≤ 400 mg/day(n = 239), sertraline ≤ 200 mg/day (238) or extended-release venlafaxine ≤ 375 mg/day, for up to 14 weeks.2Remission rates were similar for the bupropion,sertraline and venlafaxine groups at study end (21.3%,17.6% and 24.8%, respectively).

In an editorial accompanying the studies, Dr David RRubinow from the University of North Carolina, ChapelHill, US, writes that "these studies confirm thatintolerance or failure to respond to an SSRI dose notpredict a lack of efficacy or intolerance of another SSRI".4

. . . and try to be good to your motherIn another analysis, data were evaluated from

114 mother-child pairs who had psychiatricassessments before and after 3 months of treatmentduring the STAR*D trial.3 Remission was achieved by38 mothers (33%) over this period (35 of whom receivedcitalopram only). For this group, there was a significant12.3% reduction from baseline in the rate of psychiatricdiagnoses in their children, after adjusting for the child’sage and sex. In comparison, there was a nonsignificant6.5% increase in the rate of diagnoses in children whosemothers had not gone into remission.* Sequenced Treatment Alternatives to Relieve Depression** defined as a score of ≤ 7 on the 17-item Hamilton Rating Scale forDepression

1. Trivedi MH, et al. Medication augmentation after the failure of SSRIs fordepression. New England Journal of Medicine 354: 1243-1252, No. 12, 23 Mar2006.

2. Rush AJ, et al. Bupropion-SR, sertraline, or venlafaxine-XR after failure ofSSRIs for depression. New England Journal of Medicine 354: 1231-1242, No.12, 23 Mar 2006.

3. Weissman MM, et al. Remissions in maternal depression and childpsychopathology: a STAR*D-Child report. JAMA: the Journal of the AmericanMedical Association 295: 1389-1398, No. 12, 22 Mar 2006.

4. Rubinow DR. Treatment strategies after SSRI failure - good news and bad news.New England Journal of Medicine 354: 1305-1307, No. 12, 23 Mar 2006.

800999938

1

Inpharma 1 Apr 2006 No. 15311173-8324/10/1531-0001/$14.95 Adis © 2010 Springer International Publishing AG. All rights reserved