Posted by utopizen on September 24, 2004, at 6:56:06
J Clin Psychiatry. 2004 Sep;65(9):1266-1268.
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Postpartum Depression Recurrence Versus Discontinuation Syndrome: Observations From a Randomized Controlled Trial.Sunder KR, Wisner KL, Hanusa BH, Perel JM.
Departments of Psychiatry (Drs. Sunder and Wisner), Obstetrics and Gynecology and Reproductive Sciences, and Epidemiology (Dr. Wisner), and Women's Behavioral HealthCARE, Western Psychiatric Institute and Clinic, University of Pittsburgh Medical Center (Drs. Sunder, Wisner, and Perel); and the Center for Research on Health Care, Division of General Medicine, Department of Medicine, University of Pittsburgh (Dr. Hanusa), Pittsburgh, Pa.
OBJECTIVE: To differentiate characteristics of a discontinuation syndrome from a recurrence of major depressive disorder in the context of a randomized trial. METHOD: We performed a randomized clinical trial to compare the efficacy of sertraline versus placebo for the prevention of recurrent postpartum DSM-IV major depressive disorder. Women whose depression did not recur in the initial 17-week active treatment trial were followed through the taper phase (weeks 18-20). At week 17, 3 women assigned to placebo and 8 assigned to sertraline remained in the trial. Nine symptoms that characterize discontinuation syndrome were extracted from the 25-item Asberg Rating Scale for Side Effects (ASE) and assessed weekly during the taper phase. The 21-item Hamilton Rating Scale for Depression was used to evaluate depressive symptoms. RESULTS: In the taper phase, there were no significant differences between the sertraline- and placebo-treated women on the sum of the ASE-derived symptoms. Both groups had low levels of symptoms on the ASE during the weeks of taper. None of the 3 women assigned to placebo and 2 of the 8 women assigned to sertraline suffered a depressive recurrence within 6 weeks of the end of the study. CONCLUSIONS: A gradual taper of sertraline (75 mg) over 3 weeks did not lead to discontinuation syndrome; however, the systematic dissection of symptoms resulted in our conclusion that the duration of preventive therapy should be extended to 26 weeks (about 6 months) in subsequent randomized trials, consistent with the treatment guidelines for a single episode of depression.
PMID: 15367055 [PubMed - as supplied by publisher]
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