A comparison of duloxetine hydrochloride with fluoxetine hydrochloride in major depressive disorders: a pilot study

Ravinder Kumar Sah, Harmeet Singh Rehan, Kannanore Eloremadathil Sadanandan Unni, Deepti Chopra, Seema Manak, Preeta Kaur Narula

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DOI: 10.4236/health.2010.26093                

Abstract

To compare remission rate, relapse rate and tolerability of duloxetine, a dual reuptake inhibitor of 5-hydroxy serotonin (5-HT) and norepinephrine (NE), versus fluoxetine, a reuptake inhibitor of 5-HT during follow up period of 16 weeks in major depressive disorder (MDD) a open label comparative trial was conducted. Trial was comprising of 60 patients, diagnosed with MDD, were allocated to fluoxetine group (n*-30, 20-60mg od) or duloxetine group (n*-30, 40-60mg od) for 16 weeks. The end points were remission and relapse assessed by Hamilton Rating scale for Depression-24 items (HAMD-24). In results the mean fall in HAMD-24 scores between groups was comparable till 4 weeks. Thereafter, at 8 weeks the mean fall in HAMD-24 score was significantly greater in duloxetine group (p value < 0.05). At 16 weeks the mean fall was highly significant (p value < 0.01) in duloxetine group. Thirty percent patients in duloxetine group achieved remission in comparison to none in fluoxetine group. None of the patient, in any group, reported relapse. Adverse effects were mild to moderate in severity.In conclusion duloxetine has a better pharmacological profile over fluoxetine in terms of efficacy and safety.

Keywords

Major Depressive Disorder; Duloxetine;Remission; Relapse

Conflicts of Interest

The authors declare no conflicts of interest.

References

[1]	Hudson, J.I., Perahia, D.G., Gilaberte, I., Wang, F., Watkin, J.G. and Detke, M.J. (2007) Duloxetine in the treatment of major depressive disorder: An open-label study. BMC Psychiatry, 7(1), 43. http://www.biomedcentral.com
[2]	Williams, R.H.M. (2005) Duloxetine (Cymbalta): a new treatment option in depression. Prescriber, 16(12), 49-50. http://www.escriber.com
[3]	McIntyre, R.S., Muller, A., Mancini, D.A. and Silver, E.S. (2003) What to do it an initial antidepressant fails. Canadian Family Physician, 49(4), 449-457.
[4]	Gartlehner, G., Hansen, R.A., Kahwati, L., et al. (2006) Drug class review on second generation antidepressants Final Report March. Oregan Evidance based Practice Centre, Oregan Health & Science University, Portland.
[5]	Detke, M.J., Lu, Y., Goldstein, D.J., Hayes, J.R. and Demitrack, M.A. (2002) Duloxetine, 60 mg once daily for major depressive disorder: a randomized double blind placebo controlled trial. Journal of Clinical Psychiatry, 63(4), 308-315.
[6]	Detke, M.J., Lu, Y., Goldstein, D.J., McNamara, R.K. and Demitrack, M.A. (2002) Duloxetine, 60 mg once daily dosing versus placebo in the acute treatment of major depression. Journal of Psychiatric Research, 36(6), 383-390.
[7]	Goldstein, D.J., Mallinckrodt, C., Lu, Y., Demitrack and M.A. (2002) Duloxetine in the treatment of major depressive disorder: A double blind clinical trial. Journal of Clinical Psychiatry, 63(3), 225-231.
[8]	Raskin, J., Goldstein, D.J., Mallinckrodt, C.H. and Ferguson, M.B. (2003) Duloxetine in the long term treatment of major depressive disorder. Journal of Clinical Psychiatry, 64(10), 1237-1244.
[9]	Kirwin, J.L. and Gören, J.L. (2005) Duloxetine: a dual serotonin-norepinephrine reuptake inhibitor for treatment of major depressive disorder. Pharmacotherapy, 25(3), 396-410.
[10]	Depressive Episode F-32 (1992) The ICD-10 classification of mental and behavioural disorders, diagnostic criteria for research. World Health Organization, Geneva. 81-85.
[11]	Blacker, D. (2005) Psychiatric rating scales. In. Kaplan, H.I. and Sadock, B.J. Eds. Comprehensive textbook of Psychiatry, 8th Edition, Williams and Wilkins, Baltimore.
[12]	Segal, Z.V., Pearson, J.L. and Thase, M.E. (2003) Challenges in preventing relapse in major depression: Report of a National Institute of Mental Health Workshop on state of the science of relapse prevention in major depression. Journal of Affective Disorders, 77(2), 97-108.
[13]	Schweitzer, I., Burrows, G. and Tuckwell, V., et al. (2001) Sustained response to open-label venlafaxine in drug-resistant major depression. Journal of Clinical Psycho- pharmacology, 21(2), 185-189.
[14]	Goldstein, D.J., Lu, Y., Detke, M.J., Wilste, C., Mallinckrodt, C. and Demitrack, M.A. (2004) Duloxetine in the treatment of depression: A double blind placebo controlled comparison with paroxetine. Journal of Clinical Psychopharmacology, 24(4), 389-399.
[15]	McGrath, P.J., Stewart, J.W., Quitkin, F.M., et al. (2006) Predictors of Relapse in a Prospective Study of Fluoxetine Treatment of Major Depression. American Journal of Psychiatry, 163 (9), 1542-1548.
[16]	Perahia, D.G., Gilaberte, I., Wang, F., et al. (2006) Duloxetine in the prevention of relapse of major depressive disorder: a double blind placebo controlled study. British Journal of Psychiatry, 188, 346-353.
[17]	Geddes, J.R., Carney, S.M., Davis, C., et al. (2003) Relapse prevention with antidepressant drug treatment in depressive disorders: A systemic review. Lancet, 361 (9358), 653-661.
[18]	Sharma, A., Goldberg, M.J. and Cerimele, B.J. (2000) Pharmacokinetics and safety of duloxetine, a dual serotonin and norepinephrine reuptake inhibitor. Journal Clinical Pharmacology, 40(2), 161-167.
[19]	Zajecka, J., Amsterdam, J.D., Quitkin, F.M., et al. (1999) Changes in adverse events reported by patients in six months of fluoxetine therapy. Journal of Clinical Psychiatry, 60(6), 389-394.
[20]	Harman, J.B., Brotman, A.W., Pollock, M.H., Falk, W.E., Biederman, J. and Rosenbaum, J.F. (1990) Flouxetine induced sexual dysfunction. Journal of Clinical Psychiatry, 51(1), 25-27.
[21]	Detke, M.J., Lu, Y., Goldstein, D.J., Hayes, J.R. and Demitrack, M.A. (2002) Duloxetine, 60 mg once daily for major depressive disorder: A randomized double blind placebo controlled trial. Journal of Clinical Psychiatry, 63(4), 308-315.