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EARLY RESPONSE TO FLUOXETINE PREDICTS LATER OUTCOME.

When a patient with major depression fails to improve after several weeks of a standard dose of fluoxetine, how likely is a response later? To shed light on this question, researchers at Massachusetts General Hospital treated 143 depressed patients with 20 mg of fluoxetine for 8 weeks and assessed each patient's response at 2-week intervals. Overall, 57 percent of patients had a good response (i.e., a 50 percent or greater decrease in score on the Hamilton Depression Rating Scale) after the full 8 weeks of treatment. Of 66 patients who had no improvement at 2 weeks, 36 percent had a good response at 8 weeks. Of 37 patients who had not responded at 4 weeks, only 19 percent had a good response at 8 weeks. Finally, 31 patients still had no response at 6 weeks, and only 7 percent of these patients achieved a good response by week 8. Comment: According to these results, the vast majority of patients destined to respond to 20 mg of fluoxetine will do so during the first month of therapy. The authors suggest that clinicians consider changing the regimen (e.g., increasing the dose, or adding or substituting another drug) when a patient with major depression has not responded after four weeks of fluoxetine treatment.

— AS Brett

Published in Journal Watch General Medicine October 24, 1995

Citation(s):

Nierenberg AA et al. Early nonresponse to fluoxetine as a predictor of poor 8-week outcome. Am J Psychiatry 1995 Oct 152 1500-1503.

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