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A randomized clinical trial comparing two two‐phase treatment strategies for in‐patients with severe depression
Author(s) -
Vermeiden M.,
Kamperman A. M.,
Hoogendijk W. J. G.,
Broek W. W.,
Birkenhäger T. K.
Publication year - 2017
Publication title -
acta psychiatrica scandinavica
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.849
H-Index - 146
eISSN - 1600-0447
pISSN - 0001-690X
DOI - 10.1111/acps.12743
Subject(s) - venlafaxine , imipramine , lithium (medication) , antidepressant , depression (economics) , medicine , randomized controlled trial , gastroenterology , psychology , anesthesia , alternative medicine , macroeconomics , pathology , hippocampus , economics
Objective To compare the efficacy of two antidepressant treatment strategies in severely depressed in‐patients, that is, imipramine vs. venlafaxine, both with subsequent lithium addition in non‐responders. Method In‐patients ( n = 88) with major depressive disorder were randomized to 7‐week treatment with imipramine or venlafaxine (phase I). All non‐responders ( n = 44) received 4‐week plasma level‐targeted dose lithium addition (phase II ). Efficacy was evaluated after 11 weeks of treatment. Results Analyzing phases I and II combined, non‐inferiority was established and the difference in the proportion of responders ( HAM ‐D score reduction ≥50%) by the end of phase II demonstrated the venlafaxine‐lithium treatment strategy to be significantly superior to the imipramine‐lithium treatment strategy (77% vs. 52%) (χ 2 (1) = 6.03; P = 0.01). Regarding remission ( HAM ‐D score ≤ 7), 15 of 44 (34%) patients in the imipramine‐lithium treatment group were remitters compared to 22 of 44 (50%) patients in the venlafaxine‐lithium treatment group, a non‐significant difference. Patients in the venlafaxine‐lithium treatment group had a non‐significant larger mean HAM ‐D score reduction compared with patients in the imipramine‐lithium treatment group (16.1 vs. 13.5 points, respectively; Cohen's d = 0.30). Conclusion The venlafaxine‐lithium treatment strategy can be considered a valuable alternative for the imipramine‐lithium treatment strategy in the treatment of severely depressed in‐patients.