A. Serretti, A. Lucca, C. Cusin, E. Smeraldi - Vol. 7, Marzo 2001, num.1
Testo Immagini Bibliografia Summary Riassunto Indice
Associazione di reboxetina nella depressione
resistente a SSRI
Effect of reboxetine augmentation in SSRI resistant patients
Background and objective
Drug combination is common practice in psychiatry and is most used in
the treatment of drug-resistant depression; selective serotonin reuptake inhibitors
(SSRIs) have been used in combination with tricyclic antidepressants (TCAs),
according to a presynaptic interaction hypothesis between the noradrenergic
and serotonergic systems.
In this study we assessed the efficacy of the addition to established drug
treatment of subtherapeutic dosages (2-4 mg) of the norepinephrine transporter
inhibitor (NARI), reboxetine, in depressed patients who were resistant to
SSRI treatment administered for an appropriate time length and at appropriate
dosages for an antidepressive effect to show. Observable augmentation could
be due to presynaptic interactions between serotonergic and noradrenergic
systems involving presynaptic a-2 adrenergic auto- and heteroreceptors, and
resulting in the potentiation of the activity of both systems.
Method
We included in this study 27 subjects affected by a major depressive episode
without (n = 24) or with (n = 3) psychotic features, who did not show significant
clinical response after 4 weeks of administration of a full dose of an SSRI.
Results
Added-on reboxetine induced a significant decrease of depressive symptoms
(F = 47.35; d.f. = 2,52; p < 0.0001); in fact, 12 patients (44,4%) showed
complete remission, 8 (29,6%) showed partial remission and 7 (26%) no improvement.
Generally, subjects with psychotic features did not benefit from the addition
of the drug, as 2 out of 3 had to discontinue due to ineffectiveness.
Conclusion
In this preliminary study, adding-on a low reboxetine dosage to SSRI in
SSRI-nonresponders after 4 weeks of treatment, proved to be effective in reducing
depressive symptoms as well as well tolerated by our patients.