Posted by jrbecker on January 31, 2006, at 10:50:30
January 30, 2006
Psychomotor slowing in major depression may predict nonresponse to SSRIhttp://www.merckmedicus.com/pp/us/hcp/hcp_newsarticle.jsp?newsid=577377&newsgroup=2
NEW YORK (Reuters Health) - In patients with major depression, psychomotor retardation may be an indicator that treatment with a selective serotonin reuptake inhibitor (SSRI) is unlikely to be effective, investigators report. For these patients, treatment that directly targets dopamine neurotransmission may be more effective.
Psychomotor slowing is believe to represent an underlying dopaminergic abnormality, Dr. Bonnie P. Taylor and her colleagues at Columbia University in New York point out. They theorize that these patients would be less responsive to an SSRI than patients without psychomotor retardation.
They therefore had patients with major depression complete a series of neuropsychological tests prior to beginning a 12-week course of fluoxetine, titrated up from 10mg/day at week 1 to a maximum of 60 mg/day at weeks 8-12.
According to their report in the American Journal of Psychiatry for January, 37 patients completed the trial, 25 of whom were rated as fluoxetine responders and 12 rated as nonresponders.
At baseline, patients who subsequently did not respond to fluoxetine verbalized significantly fewer words on the Controlled Oral Word Association test FAS (COWAT FAS) and named significantly fewer colors on the Stroop Color and Word Test compared with responders.
There was a significant inverse correlation between the COWAT FAS scores and the week 12 scores on the 17-item Hamilton Depression Rating Scale (p = 0.001).
Tests of psychomotor speed, such as the COWAT FAS, are noninvasive, of minimal cost, and can be performed quickly, Dr. Taylor's group notes. If psychomotor speed can be used to identify patients who are unlikely to respond to one class of drugs, another class could be initiated, thus reducing the time to symptom relief and increasing treatment compliance.
Am J Psychiatry 2006;163:73-78.
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