18
views
0
recommends
+1 Recommend
1 collections
    0
    shares
      • Record: found
      • Abstract: found
      • Article: found
      Is Open Access

      Treatment discontinuation and tolerability as a function of dose and titration of duloxetine in the treatment of major depressive disorder

      research-article

      Read this article at

      ScienceOpenPublisherPMC
      Bookmark
          There is no author summary for this article yet. Authors can add summaries to their articles on ScienceOpen to make them more accessible to a non-specialist audience.

          Abstract

          Purpose

          We sought to better understand how dose and titration with duloxetine treatment may impact tolerability and treatment discontinuation in patients with major depressive disorder.

          Patients and methods

          We investigated Phase III duloxetine trials. Group 1 was a single placebo-controlled study with a 20 mg initial dose and a slow titration to 40 and 60 mg. Group 2 was a single study with a 40 mg initial dose and final “active” doses of 40 and 60 mg (5 mg control group), with 1-week titration. Group 3 consisted of eight placebo-controlled studies with starting doses of 40, 60, and 80 mg/day with minimal titration (final dose 40–120 mg/day). Tolerability was measured by rate of discontinuation due to adverse events (DCAE).

          Results

          The DCAE in Group 1 were 3.6% in the 60 mg group, 3.3% in the 40 mg group, and 3.2% in the placebo group. In Group 2, the DCAE were 15.0% in the 60 mg group, 8.1% in the 40 mg group, and 4.9% in the 5 mg group. In Group 3, the DCAE were 9.7% and 4.2% in the duloxetine and placebo groups, respectively.

          Conclusion

          This study suggests that starting dose and titration may have impacted tolerability and treatment discontinuation. A lower starting dose of duloxetine and slower titration may contribute to improving treatment tolerability for patients with major depressive disorder.

          Related collections

          Most cited references32

          • Record: found
          • Abstract: not found
          • Article: not found

          Diagnostic and statistical manual of mental disorders.

            Bookmark
            • Record: found
            • Abstract: found
            • Article: found
            Is Open Access

            The world health report 2001 - Mental health: new understanding, new hope

              Bookmark
              • Record: found
              • Abstract: found
              • Article: not found

              Discontinuation of use and switching of antidepressants: influence of patient-physician communication.

              Although current depression treatment guidelines recommend continuing antidepressant therapy for at least 4 to 9 months, many patients discontinue treatment prematurely, within 3 months. To investigate the relationship between patient-physician communication and the continuation of treatment with antidepressants and to explore the demographics, adverse effects, therapeutic response, and frequency of follow-up visits. A total of 401 telephone interviews of depressed patients being treated with selective serotonin reuptake inhibitor (SSRI) therapy between December 15, 1999, and May 31, 2000, were conducted and 137 prescribing physicians completed written surveys from Northern California Kaiser Permanente health maintenance organization outpatient clinics. Patient-physician communication about therapy duration and about adverse effects; therapy discontinuation or medication switching within 3 months after start of SSRI therapy. Ninety-nine physicians (72%) reported that they usually ask patients to continue using antidepressants for at least 6 months, but 137 patients (34%) reported that their physicians asked them to continue using antidepressants for this duration and 228 (56%) reported receiving no instructions. Patients who said they were told to take their medication for less than 6 months were 3 times more likely to discontinue therapy (odds ratio [OR], 3.12; 95% confidence interval [CI], 1.21-8.07) compared with patients who said they were told to continue therapy longer. Patients who discussed adverse effects with their physicians were less likely to discontinue therapy than patients who did not discuss them (OR, 0.49; 95% CI, 0.25-0.95). Patients who reported discussing adverse effects with their physicians were more likely to switch medications (OR, 5.60; 95% CI, 2.31-13.60). Fewer than 3 follow-up visits for depression, adverse effects, and lack of therapeutic response to medication were also associated with patients' discontinuing therapy. Discrepancies exist between instructions that physicians report they communicate to patients and what patients remember being told. Explicit instructions about expected duration of therapy and discussions about medication adverse effects throughout treatment may reduce discontinuation of SSRI use. Our finding that patients with 3 or more follow-up visits were more likely to continue using the initially prescribed antidepressant medication suggests that frequent patient-physician contact may increase the probability that patients will continue therapy.
                Bookmark

                Author and article information

                Journal
                Neuropsychiatr Dis Treat
                Neuropsychiatr Dis Treat
                Neuropsychiatric Disease and Treatment
                Neuropsychiatric Disease and Treatment
                Dove Medical Press
                1176-6328
                1178-2021
                2016
                11 January 2016
                : 12
                : 89-97
                Affiliations
                [1 ]Eli Lilly Japan K.K., Medicines Development Unit Japan, Medical Science, Kobe, Japan
                [2 ]Department of Neuropsychiatry, Kinki University Faculty of Medicine, Osakasayama, Japan
                [3 ]Eli Lilly Japan K.K., Medicines Development Unit Japan, Statistical Science, Kobe, Japan
                [4 ]The University of Texas Health Science Center School of Medicine, Houston, TX, USA
                [5 ]Eli Lilly and Company, Neuroscience, Indianapolis, IN, USA
                Author notes
                Correspondence: Yoichi Satoi, Eli Lilly Japan K.K., Lilly Research Laboratories Japan, 6510086, Kobe, Japan, Tel +81 78 242 9185, Fax +81 78 242 9526, Email satoi_yoichi@ 123456lilly.com
                Article
                ndt-12-089
                10.2147/NDT.S86598
                4714731
                97833c23-625d-4649-be79-e4e8ac22f4b7
                © 2016 Harada et al. This work is published by Dove Medical Press Limited, and licensed under Creative Commons Attribution – Non Commercial (unported, v3.0) License

                The full terms of the License are available at http://creativecommons.org/licenses/by-nc/3.0/. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed.

                Categories
                Original Research

                Neurology
                antidepressant,dose,duloxetine,major depressive disorder,titration
                Neurology
                antidepressant, dose, duloxetine, major depressive disorder, titration

                Comments

                Comment on this article