Duloxetine: A Balanced and Selective Norepinephrine and Serotonin-Reuptake Inhibitor

Anders D. Westanmo; Jon Gayken; Robert Haight


Am J Health Syst Pharm. 2005;62(23):2481-2490. 

In This Article

Clinical Efficacy

The Agency for Healthcare Research and Quality (AHRQ) (formerly the Agency for Health Care Policy and Research) has identified three major objectives for the treatment of MDD with antidepressants: remission of depressive symptoms, return of the patient's normal social and occupational functioning, and prevention of recurrence or relapse.[38] AHRQ, the American Psychiatric Association, the American College of Physicians, and the American Society of Internal Medicine recommend three phases of antidepressant treatment: acute, continuation, and maintenance.[38–40]

Clinically, remission means the complete relief of an individual's depressive symptoms (i.e., the patient no longer meets the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition [DSM-IV], criteria for MDD). When measured during a clinical trial, remission of depressive symptoms may correspond to a score of 7 or less on the 17-item Hamilton Depression Rating Scale (HAMD17).[41] Compared with remission, a response to antidepressant treatment is defined as a 50% reduction in the HAMD17 score. Even though a patient may exhibit a response, he or she may still meet diagnostic criteria for MDD. Patients who respond to treatment but do not achieve remission have a much greater risk of relapse. In one study that followed patients for 10 years, those who were not treated to remission relapsed three times more rapidly than those who were treated to remission.[42] Those patients also tended to have more recurrences, with shorter intervals between recurrences.[43]

The goal of the acute treatment phase is complete remission of a patient's depressive symptoms.[38,39] The recommended length of the acute treatment phase may vary for each individual patient but is approximately six to eight weeks.[38,39] Treatment during the continuation phase lasts 16–20 weeks after acute-phase remission and may help prevent symptom relapse during a vulnerable period following asymptomatic recovery.[38–40] Maintenance treatment should be considered for patients who may be at risk for recurrence of a major depressive episode.[38,39] The optimal length of maintenance therapy is not known, but indefinite treatment may be required for some patients.[38,39]