Dold, Markus and Bartova, Lucie and Rupprecht, Rainer and Kasper, Siegfried (2017) Dose Escalation of Antidepressants in Unipolar Depression: A Meta-Analysis of Double-Blind, Randomized Controlled Trials. PSYCHOTHERAPY AND PSYCHOSOMATICS, 86 (5). pp. 283-291. ISSN 0033-3190, 1423-0348
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Background: As many patients with unipolar depression do not respond sufficiently to initial antidepressant monotherapy, a dose increase of the current administered antidepressant (dose escalation, high-dose treatment) is frequently carried out as next treatment measure. Methods: We conducted a meta-analysis which included all double-blind randomized controlled trials (RCTs) comparing a dose increase of antidepressants directly to continuation of standard-dose treatment in unipolar depressive patients who were non-responders to standard-dose pharmacotherapy. A mean change in the Hamilton Rating Scale for Depression (HAM-D) total score was the primary outcome. Secondary outcomes were response rates and discontinuation rates due to any reason, inefficacy, and adverse effects. Hedges g and risk ratios were calculated as effect sizes. Results: Seven double-blind RCTs (8 study arms) representing 1,208 participants were included. Fluoxetine (N [number of studies] = 2, n [number of patients] = 448), sertraline (N = 2, n = 272), paroxetine (N = 2, n = 146), duloxetine (N = 1, n = 255), and maprotiline (N = 1, n = 87) were investigated. Dose escalation was not more efficacious in HAM-D total score reduction than maintaining standard-dose treatment, neither for the pooled antidepressant group (N = 7, n = 999; Hedges g = -0.04, 95% CI: -0.20 to 0.12; p = 0.63) nor the individual antidepressants. No differences could be determined for response rates, all-cause discontinuation, and drop-outs due to inefficacy. Significantly more patients in the dose escalation group dropped out due to adverse effects than in the standard-dose continuation group. The metaregressions indicate no influence of baseline symptom severity or amounts of dose increments on effect sizes. Conclusions: According to our meta-analytic findings, dose escalation after initial non-response to standard-dose pharmacotherapy cannot be regarded as general evidence-based treatment option in unipolar depression. (C) 2017 S. Karger AG, Basel
| Item Type: | Article |
|---|---|
| Uncontrolled Keywords: | TREATMENT-RESISTANT DEPRESSION; SEROTONIN REUPTAKE INHIBITORS; PSYCHIATRY WFSBP GUIDELINES; MAJOR DEPRESSION; BIOLOGICAL TREATMENT; TREATMENT STRATEGIES; WORLD FEDERATION; FLUOXETINE; AUGMENTATION; DISORDER; Depression; Antidepressants; Treatment resistance; Non-response; High-dose treatment |
| Subjects: | 100 Philosophy & psychology > 150 Psychology |
| Divisions: | Psychology and Pedagogy > Institut für Psychologie |
| Depositing User: | Dr. Gernot Deinzer |
| Date Deposited: | 14 Dec 2018 13:01 |
| Last Modified: | 19 Feb 2019 14:52 |
| URI: | https://pred.uni-regensburg.de/id/eprint/640 |
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