주요 정신과적 질환에서 Duloxetine 단독요법과 다른 항우울제와의 병합요법의 효과 비교 : 단기간, 후향적 연구
Effectiveness of Duloxetine Monotherapy Compared to Combination Therapy with Other Antidepressants in Patients with Major Psychiatric Disorders : A Short-Term, Retrospective Study
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Background：Duloxetine is an antidepressant that effects a serotonergic and noradrenergic neurotransmitter, and a useful agent in the treatment of the patients with depressive or anxiety or somatoform disorders. According to the recently reported study results, combination therapy with other antidepressants in the treatment of patients with major depressive disorder did not show a superior efficacy but might have a greater risk of producing adverse events. But, combination strategy is still most commonly used to make clinical improvement in clinical practice. Objectives：The purpose of this study was to compare duloxetine monotherapy to combination therapy with other antidepressants in patients with depressive, anxiety or somatoform disorders. Methods：An 8-week, naturalistic, retrospective, multi-center study in outpatients with depressive, anxiety or somatoform disorders was undertaken. A total of 174 patients that had been taken with duloxetine were enrolled in this study from July, 2009 to June, 2014 through 3 centers. We compared the mean changes of the Clinical Global Impression Scale-Severity(CGI-S) as primary efficacy measure and the discontinuation rate and adverse effect as secondary measures between duloxetine monotherapy group(n=71) and combination therapy with other antidepressants group (n=103) at baseline, 1, 2, 4, 8 week. Results：There were no significant differences across the demographic characteristics between duloxetine monotherapy group and combination therapy group. There was a statistically greater improvement on the CGI-S in the combination group compared with the monotherapy group in patients with depressive(p=0.04) and anxiety disorders(p=0.02). There were no significant difference in the discontinuation rate and adverse event between duloxetine monotherapy group and combination therapy group. Conclusion：Despite the limitation of our retrospective study, this results suggest that duloxetine combination therapy with other antidepressants compared to monotherapy would have a superior efficacy and similar tolerability in the treatment of patients with depressive and anxiety disorders. Adequately powered, well-controlled clinical trials are strongly warranted to confirm our findings due to methodological shortcomings.
Abstract
Background：Duloxetine is an antidepressant that effects a serotonergic and noradrenergic neurotransmitter, and a useful agent in the treatment of the patients with depressive or anxiety or somatoform disorders. According to the recently reported study results, combination therapy with other antidepressants in the treatment of patients with major depressive disorder did not show a superior efficacy but might have a greater risk of producing adverse events. But, combination strategy is still most commonly used to make clinical improvement in clinical practice. Objectives：The purpose of this study was to compare duloxetine monotherapy to combination therapy with other antidepressants in patients with depressive, anxiety or somatoform disorders. Methods：An 8-week, naturalistic, retrospective, multi-center study in outpatients with depressive, anxiety or somatoform disorders was undertaken. A total of 174 patients that had been taken with duloxetine were enrolled in this study from July, 2009 to June, 2014 through 3 centers. We compared the mean changes of the Clinical Global Impression Scale-Severity(CGI-S) as primary efficacy measure and the discontinuation rate and adverse effect as secondary measures between duloxetine monotherapy group(n=71) and combination therapy with other antidepressants group (n=103) at baseline, 1, 2, 4, 8 week. Results：There were no significant differences across the demographic characteristics between duloxetine monotherapy group and combination therapy group. There was a statistically greater improvement on the CGI-S in the combination group compared with the monotherapy group in patients with depressive(p=0.04) and anxiety disorders(p=0.02). There were no significant difference in the discontinuation rate and adverse event between duloxetine monotherapy group and combination therapy group. Conclusion：Despite the limitation of our retrospective study, this results suggest that duloxetine combination therapy with other antidepressants compared to monotherapy would have a superior efficacy and similar tolerability in the treatment of patients with depressive and anxiety disorders. Adequately powered, well-controlled clinical trials are strongly warranted to confirm our findings due to methodological shortcomings.
참고문헌 (40)
- Kessler RC, "Lifetime prevalence and age-of-onset distributions of DSM-IV disorders in the National Comorbidity Survey Replication", Arch Gen Psychiatry, 62, pp.593~602 (2005)
- Kessler RC, "Prevalence, severity, and comorbidity of 12-month DSM-IV disorders in the National Comorbidity Survey Replication", Arch Gen Psychiatry, 62, pp.617~627 (2005)
- Byers AL, "High occurrence of mood and anxiety disorders among older adults: The National Comorbidity Survey Replication", Arch Gen Psychiatry, 67, pp.489~496 (2010)
- Wittchen HU, "Generalized anxiety and depression in primary care: prevalence, recognition, and management", J Clin Psychiatry, 63(Suppl 8), pp.24~34 (2002)
- Rofman ES, "Kaplan and Sadock’s Synopsis of Psychiatry:Behavioral sciences", Clinical psychiatry, 2009, pp.70, 940~
- American Psychiatric Association, "Diagnostic criteria from DSM-IV-TR" (2000), American Psychiatric Association
- Benzamin JS, "Kaplan & Sadock’s synopsis of psychiatry"
- Keller MB, "The treatment of chronic depression, part 2: a double-blind, randomized trial of sertraline and imipramine", J Clin Psychiatry, 59, pp.598~607 (1998)
- Kennedy SH, "Antidepressants in clinical practice: limitations of assessment methods and drug response", Hum Psychopharmacol, 16, pp.105~114 (2001)
- Nemeroff CB, "Comprehensive analysis of remission (COMPARE) with venlafaxine versus SSRIs", Biol Psychiatry, 63, pp.424~434 (2008)
- Trivedi MH, "Evaluation of outcomes with citalopram for depression using measurement-based care in STAR*D: implications for clinical practice", Am J Psychiatry, 163, pp.28~40 (2006)
- Keller MB, "A comparison of nefazodone, the cognitive behavioral-analysis system of psychotherapy, and their combination for the treatment of chronic depression", N Engl J Med, 342, pp.1462~1470 (2000)
- Blier P, "Combination of antidepressant medications from treatment initiation for major depressive disorder: a double-blind randomized study", Am J Psychiatry, 167, pp.281~288 (2010)
- Carpenter LL, "A double-blind, placebo-controlled study of antidepressant augmentation with mirtazapine", Biol Psychiatry, 51, pp.183~188 (2002)
- Fava M, "Efficacy and safety of mirtazapine in major depressive disorder patients after SSRI treatment failure: an open-label trial", J Clin Psychiatry, 62, pp.413~420 (2001)
- Lam RW, "Citalopram and bupropion-SR: combining versus switching in patients with treatment-resistant depression", J Clin Psychiatry, 65, pp.337~340 (2004)
- Rush AJ, "Bupropion-SR, sertraline, or venlafaxine-XR after failure of SSRIs for depression", N Engl J Med, 354, pp.1231~1242 (2006)
- Trivedi MH, "Medication augmentation after the failure of SSRIs for depression", N Engl J Med, 354, pp.1243~1252 (2006)
- Montgomery SA, "A new depression scale designed to be sensitive to change", Br J Psychiatry, 134, pp.382~389 (1979)
- Blier P, "Mirtazapine and paroxetine in major depression: a comparison of monotherapy versus their combination from treatment initiation", Eur Neuropsychopharmacol, 19, pp.457~465 (2009)
- Alaka KJ, "Efficacy and safety of duloxetine in the treatment of older adult patients with generalized anxiety disorder: a randomized, double-blind, placebo-controlled trial", Int J Geriatr Psychiatry, 29, pp.978~986 (2014)
- Strawn JR, "A randomized, placebo-controlled study of duloxetine for the treatment of children and adolescents with generalized anxiety disorder", J Am Acad Child Adolesc Psychiatry, 54, pp.283~293 (2015)
- Simon NM, "Open-label support for duloxetine for the treatment of panic disorder", CNS Neurosci Ther, 15, pp.19~23 (2009)
- Guy W, "ECDEU Assessment manual for psychopharmacology", pp.218~222 (1976), NIMH Psychopharmacology Research Branch, Division of Extramural Research Programs
- Nierenberg AA, "Treatment-resistant depression: definition and treatment approaches", J Clin Psychiatry, 51(Suppl), pp.39~47 (1990)
- Thase ME, "The need for clinically relevant research on treatment-resistant depression", J Clin Psychiatry, 62, pp.221~224 (2001)
- Nelson JC, "Combining norepinephrine and serotonin reuptake inhibition mechanisms for treatment of depression: a double-blind, randomized study", Biol Psychiatry, 55, pp.296~300 (2004)
- Frye MA, "The increasing use of polypharmacotherapy for refractory mood disorders: 22 years of study", J Clin Psychiatry, 61, pp.9~15 (2000)
- Mischoulon D, "Strategies for managing depression refractory to selective serotonin reuptake inhibitor treatment: a survey of clinicians", Can J Psychiatry, 45, pp.476~481 (2000)
- Rush AJ, "Combining medications to enhance depression outcomes(CO-MED): acute and long-term outcomes of a single-blind randomized study", Am J Psychiatry, 168, pp.689~701 (2011)
- Pittenger C, "Pharmacological treatment of obsessive-compulsive disorder", Psychiatr Clin North Am, 37, pp.375~391 (2014)
- Pallanti S, "Citalopram intravenous infusion in resistant obsessive-compulsive disorder: an open trial", J Clin Psychiatry, 63, pp.796~801 (2002)
- Uguz F, "Low-dose mirtazapine added to selective serotonin reuptake inhibitors in pregnant women with major depression or panic disorder including symptoms of severe nausea, insomnia and decreased appetite: three cases", J Matern Fetal Neonatal Med, 26, pp.1066~1068 (2013)
- K-I K, "Culture and somatization", Korean J Psychosomatic Medicine, 11, pp.3~14 (2003)
- Mease PJ, "Long-term safety, tolerability, and efficacy of duloxetine in the treatment of fibromyalgia", Semin Arthritis Rheum, 39, pp.454~464 (2010)
- Brannan SK, "Duloxetine 60 mg once-daily in the treatment of painful physical symptoms in patients with major depressive disorder", J Psychiatr Res, 39, pp.43~53 (2005)
- Arnold LM, "A randomized, double-blind, placebo-controlled trial of duloxetine in the treatment of women with fibromyalgia with or without major depressive disorder", Pain, 119, pp.5~15 (2005)
- Kleinstauber M, "Pharmacological interventions for somatoform disorders in adults", Cochrane Database Syst Rev, 11, pp.CD010628~ (2014)
- Keitner GI, "A randomized, placebo-controlled trial of risperidone augmentation for patients with difficult-to-treat unipolar, non-psychotic major depression", J Psychiatr Res, 43, pp.205~214 (2009)
- Berman RM, "Aripiprazole augmentation in major depressive disorder: a double-blind, placebo-controlled study in patients with inadequate response to antidepressants", CNS Spectr, 14, pp.197~206 (2009)