Acute Worsening of Chronic Depression During a Double-Blind, Randomized Clinical Trial of Antidepressant Efficacy: Differences by Sex and Menopausal Status
Abstract
OBJECTIVE: Acute worsening of depression can negatively impact the outcomes of clinical trials of antidepressants and patient compliance to treatment. We hypothesized that acute worsenings would be more frequent in premenopausal women, relative to men or postmenopausal women, and in women who had demonstrated premenstrual symptom exacerbations (PMEs) prior to treatment, relative to those who had demonstrated no PMEs. METHOD: Subjects diagnosed with DSM-III-R chronic major depressive disorder or double depression (dysthymia with concurrent major depressive episode) were randomly assigned between February 1993 and December 1994 to 12 weeks of double-blind treatment with flexibly-dosed sertraline or imipramine, with crossover to the alternate drug in the absence of response. A 6-point or more increase in the 17-item Hamilton Rating Scale for Depression relative to the (7-14 day) previous visit defined worsening. PME was assessed through daily diaries prior to treatment. RESULTS: There were 3582 evaluable visits attended by 554 subjects. Premenopausal women had a deteriorating depressive presentation at a greater proportion of their visits (8.6%) than did postmenopausal women (4.5%, p < .01) or men (5.9%, p < .01). The presence of PME at baseline was associated with more worsenings than the absence of PME (12.0% vs. 7.3%, p < .05). Results were similar whether the subject was treated with sertraline or imipramine. Nonresponse at treatment completion was more likely among subjects with worsening (p < .01). Dropouts were more likely than completers to have had an exacerbation at their terminal visit (p < .05). CONCLUSION: Acute worsening of depression was associated with reproductive variables and negatively affected clinical trial outcomes including early treatment discontinuation and nonresponse.
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The occurrence of paradoxical effects was reported in double-blind placebo-controlled investigations that were concerned with fluoxetine and sertraline.
“The occurrence of paradoxical effects was reported in double-blind placebo-controlled investigations that were concerned with fluoxetine and sertraline.”
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- Authors
- Harvey, A. T., Silkey, B. S., Kornstein, S. G., & Clary, C. M.
- Venue
- The Journal of Clinical Psychiatry
- Publisher
- Physicians Postgraduate Press, Inc
- Published
- 2007-06-15
- Volume
- 68
- Issue
- 06
- Pages
- 951-958
- ISSN
- 0160-6689 (ISSN-L)
- OpenAlex
- W1965596580
- Cited by
- 21
- References
- 0
- Citations by year
- 2026: 1 · 2024: 2 · 2021: 2 · 2020: 1 · 2017: 1 · 2016: 2 · 2014: 1 · 2013: 2
- FWCI
- 1.53
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- The Journal of Clinical Psychiatry (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Pharmacology › Treatment of Major Depression
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
- Health Sciences › Medicine › Psychiatry and Mental health › Bipolar Disorder and Treatment
- Keywords
- double depression, dysthymia, premenstrual exacerbation, premenopausal women, menopause, sertraline, imipramine, antidepressant response, treatment non-response, treatment discontinuation, reproductive factors
- MeSH terms
- Adult, Major Depressive Disorder, Double-Blind Method, Female, Humans, Imipramine, Male, Menopause, Middle Aged, Patient Dropouts, Sex Factors, Treatment Outcome, Disease Progression, Cross-Over Studies, Dysthymic Disorder, Sertraline
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