Refractory Depression May Respond to Olanzapine-Fluoxetine Combination

Refractory Depression May Respond to Olanzapine-Fluoxetine Combination

NEW YORK (Reuters Health) Apr 20 - An analysis of five clinical trials of treatment-resistant depression indicates that olanzapine and fluoxetine in combination (OFC) are more effective than either agent alone.

As reported in the March issue of the Journal of Clinical Psychiatry, Dr. Madhukar H. Trivedi of the University of Texas Southwestern Medical Center at Dallas and colleagues studied data on three trials that compared OFC with monotherapy. Also included was a further trial of OFC versus fluoxetine, olanzapine, and nortriptyline, and one that compared OFC with fluoxetine, olanzapine, and venlafaxine.

Overall, a total of 1146 patients who had shown no response during open-label lead-in trial phases were randomized to OFC or to olanzapine or fluoxetine monotherapy.

After 8 weeks, the combination groups showed a mean increase in Montgomery-Asberg Depression Rating Scale of 13.0. There was a significant drop of 8.6 in the fluoxetine patients and 8.2 in those given olanzapine.

The remission rates were 25.5% for OFC, 17.3% for fluoxetine and 14.0% for olanzapine.

A 7% or more increase in body weight occurred in 40.4% of OFC patients, r 42.9% of those on olanzapine, but only 2.3% of fluoxetine patients.

In addition, significantly more OFC patients (10.2%) showed an increase from normal to high cholesterol level during treatment than did those in the fluoxetine group (3.1%). Cholesterol levels also increased significantly with olanzapine (in 8.0%).

The researchers call for longer-term studies, but conclude that overall, the findings "provide supporting evidence for the use of OFC following the second antidepressant treatment failure in a given depressive episode."