Comparison of Two-Phase Treatment With Imipramine or Fluvoxamine, Both Followed by Lithium Addition, in Inpatients With Major Depressive Disorder

• Published in: The American journal of psychiatry 2004-11, Vol.161 (11), p.2060-2065
• Main Authors: Birkenhäger, Tom K., van den Broek, Walter W., Mulder, Paul G., Bruijn, Jan A., Moleman, Peter
• Format: Article
• Language: English
• Subjects: Adult; Adult and adolescent clinical studies; Aged; Antidepressive Agents, Tricyclic - therapeutic use; Biological and medical sciences; Depression; Depressive Disorder, Major - diagnosis; Depressive Disorder, Major - drug therapy; Depressive Disorder, Major - psychology; Drug Administration Schedule; Drug therapy; Drug Therapy, Combination; Female; Fluvoxamine - therapeutic use; Hospitalization; Humans; Imipramine - therapeutic use; Lithium - therapeutic use; Male; Medical sciences; Medical treatment; Mental depression; Middle Aged; Mood disorders; Neuropharmacology; Pharmacology. Drug treatments; Psychiatric Status Rating Scales; Psychoanaleptics: cns stimulant, antidepressant agent, nootropic agent, mood stabilizer..., (alzheimer disease); Psychology. Psychoanalysis. Psychiatry; Psychopathology. Psychiatry; Psychopharmacology; Serotonin Uptake Inhibitors - therapeutic use; Severity of Illness Index; Treatment Outcome
• ISSN: 0002-953X; 1535-7228
• DOI: 10.1176/appi.ajp.161.11.2060

OBJECTIVE: This study was designed to compare the efficacy of two two-phase pharmacological treatment strategies for inpatients with DSM-IV major depressive disorder. METHOD: During phase I, patients participated in a double-blind study of the effects of imipramine versus fluvoxamine, with final evaluation of response 4 weeks after patients attained the target plasma level. In phase II, for patients without treatment response or with partial response in phase I, lithium was added to imipramine or fluvoxamine. Final evaluation of response was made 3 weeks after the patients attained the target plasma level of lithium (0.6-1.0 mmol liter). RESULTS: One hundred thirty-eight patients were enrolled in the study. At the end of phase I, remission, defined as a final Hamilton Depression Rating Scale score ≤7, was achieved by 16 (23%) of 70 imipramine-treated patients and 10 (15%) of 68 fluvoxamine-treated patients. At the end of phase II, 41 (59%) of 70 imipramine-treated patients versus 27 (40%) of 68 fluvoxamine-treated patients qualified for remission, a significant difference in favor of the imipramine strategy. Only a small minority of both groups received concomitant medication. In both phase I and phase II, the discontinuation rate was low (5% and 10%, respectively). CONCLUSIONS: Imipramine with subsequent lithium addition is superior to a similar strategy with fluvoxamine for treatment of severely depressed inpatients. Both strategies were well tolerated.