Residual symptoms in depressed patients who respond acutely to fluoxetine
Abstract
BACKGROUND: Antidepressants have unequivocal efficacy as compared with placebo, but many patients have residual symptoms despite a robust response to antidepressant therapy. The purpose of this study is to assess residual symptoms in outpatients who respond acutely to fluoxetine. METHOD: Two hundred and fifteen outpatients with major depressive disorder as assessed with the Structured Clinical Interview for DSM-III-R (SCID-P) were treated openly with fluoxetine 20 mg/day for 8 weeks. One hundred and eight (50.2%) were considered full responders (final 17-item Hamilton Rating Scale for Depression [HAM-D] score < or =7). Percentages of full responders who continued to have subthreshold or full major depressive disorder symptoms were calculated. The relationship between residual symptoms and Axis I and Axis II (assessed with SCID-II for personality disorders) comorbidity was assessed. RESULTS: Of the 108 responders, 19 (17.6%) had no subthreshold or threshold SCID-P major depressive disorder symptoms, while 28 (25.9%) had 1 symptom, and 61 (56.5%) had 2 or more symptoms. No statistically significant relationships were found between number of residual symptoms and selected Axis I comorbid conditions or total number of Axis II disorders. CONCLUSION: Less than 20% of full responders to fluoxetine by HAM-D criteria were free of all SCID-P subthreshold and threshold major depressive disorder symptoms after 8 weeks of treatment. While depressed patients benefit from antidepressants, most continue to have some symptoms of depression. The high prevalence of residual symptoms among antidepressant responders suggests the need for further study including whether residual symptoms abate with longer treatment or increased dose of fluoxetine. Other strategies, such as cognitive behavioral therapy, may be needed to address residual symptoms.
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From Non-Pharmacological Treatment of Insomnia (2012) · cites this paper as [42]
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“These symptoms may persist in patients who are treated for depression and are otherwise considered responders to established antidepressant regimens (2), or may remit but return during recurring depressive episodes.”
BackgroundSelf-citationFatigue in Parkinson's disease
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“In a study of fluoxetine, a selective serotonin reuptake inhibitor (SSRI), 38% of subjects whose depression improved remained fatigued [67].”
BackgroundSerotonin Receptor 2A Gene Polymorphism (–1438A/G) and Short-Term Treatment Response to Citalopram
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“Disturbed sleep is also a common residual symptom of treated MDD [19] and therefore places patients at risk for a protracted course of this chronic episodic disorder.”
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Citalopram: a comprehensive review
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“The persistence of residual symptoms in many subjects makes it an important outcome of treatment (Paykel et al, 1995; Van Londen et al, 1998; Nierenberg et al, 1999).”
BackgroundInsomnia and depression: clinical associations and possible mechanistic links
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Assessing insomnia severity in depression: comparison of depression rating scales and sleep diaries
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“Disturbed sleep is also the most common residual symptom following the acute phase of fluoxetine therapy of major depression, present in approximately 44% of treatment completers (Nierenberg et al., 1999).”
Background
- Authors
- Nierenberg, A. A., Keefe, B. R., Leslie, V. C., Alpert, J. E., Pava, J. A., Worthington, J. J., Rosenbaum, J. F., & Fava, M.
- Affiliations
- Massachusetts General Hospital (US)
- Harvard University (US)
- Venue
- The Journal of Clinical Psychiatry
- Publisher
- Physicians Postgraduate Press, Inc
- Published
- 1999-04-15
- Volume
- 60
- Issue
- 4
- Pages
- 221-225
- ISSN
- 0160-6689 (ISSN-L)
- OpenAlex
- W2056454671
- Cited by
- 470
- References
- 0
- Citations by year
- 2026: 8 · 2025: 7 · 2024: 13 · 2023: 13 · 2022: 11 · 2021: 10 · 2020: 9 · 2019: 19 · 2018: 10 · 2017: 8 · 2016: 16 · 2015: 22 · 2014: 17 · 2013: 19 · 2012: 30
- FWCI
- 3.48
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- The Journal of Clinical Psychiatry (publishedVersion)
- PubMed (publishedVersion)
- Funders
- National Institutes of Health (1r01mh048483-01a1)
- National Institute of Mental Health (R01 MH48483-01)
- Topics
- Health Sciences › Medicine › Pharmacology › Treatment of Major Depression
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
- Social Sciences › Psychology › Social Psychology › Mental Health Treatment and Access
- Keywords
- residual depressive symptoms, fluoxetine, major depressive disorder, antidepressant response, subthreshold depression, comorbidities, personality disorders, outpatients, cognitive behavioral therapy
- MeSH terms
- Adult, Ambulatory Care, Depressive Disorder, Dose-Response Relationship, Drug, Drug Administration Schedule, Female, Fluoxetine, Humans, Male, Middle Aged, Personality Disorders, Psychiatric Status Rating Scales, Comorbidity, Cognitive Behavioral Therapy, Prevalence, Treatment Outcome, Selective Serotonin Reuptake Inhibitors, Age of Onset
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