Treatment strategies in patients with major depression not responding to first-line sertraline treatment: A randomised study of extended duration of treatment, dose increase or mianserin augmentation

• Published in: Psychopharmacologia 2002-05, Vol.161 (2), p.143-151
• Main Authors: LICHT, Rasmus W, QVITZAU, Susanne
• Format: Article
• Language: English
• Subjects: Administration, Oral; Adolescent; Adult; Aged; Antidepressive Agents - administration & dosage; Biological and medical sciences; Confidence Intervals; Depressive Disorder, Major - drug therapy; Depressive Disorder, Major - psychology; Dose-Response Relationship, Drug; Double-Blind Method; Drug Therapy, Combination; Female; Humans; Logistic Models; Male; Medical sciences; Mianserin - therapeutic use; Middle Aged; Neuropharmacology; Pharmacology. Drug treatments; Psychoanaleptics: cns stimulant, antidepressant agent, nootropic agent, mood stabilizer..., (alzheimer disease); Psychology. Psychoanalysis. Psychiatry; Psychopharmacology; Sertraline - administration & dosage; Statistics, Nonparametric
• ISSN: 0033-3158; 1432-2072
• DOI: 10.1007/s00213-002-0999-0

A large proportion of patients with major depression do not respond sufficiently to any first-line treatment. The aim of this study was to compare a strategy of sertraline dose increase with a strategy of adding mianserin in patients with major depression insufficiently responding to 6 weeks of open treatment with sertraline, controlling for the effect of an extended duration of treatment. One thousand six hundred and twenty-nine patients, 18-65 years of age, with major depression scoring at least 18 on the 17-item Hamilton depression scale (HDS) were treated openly with 50 mg/day sertraline, and patients who after 4 weeks had not responded (achieving at least a 50% reduction in score on the HDS) were treated with 100 mg/day sertraline for an additional 2-week period. The patients who had still not responded were then randomised to double-blind treatment for an additional 5 weeks with either 100 mg/day sertraline plus placebo, 200 mg/day sertraline plus placebo or 100 mg/day sertraline plus 30 mg/day mianserin. After 6 weeks of open treatment, 60% had responded and 22% had dropped out, leaving 295 non-responding patients (18%) for randomisation. In the intention-to-treat-analysis, continuing the treatment with 100 mg/day sertraline resulted in response in 70% of the non-responders, similar to the response rate (67%) obtained in the patients who had mianserin added. However, increasing the sertraline dose to 200 mg/day resulted in a lower response rate at 56% ( P