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Some doctors boost dose after 4 weeks: time to antidepressant response underestimated.(Clinical Rounds)
PARIS -- A patient with depression may take as long as 8 weeks to respond to treatment with an antidepressant, and the length of this possible lag is often underestimated by physicians, Dr. Andrew A. Nierenberg said at the 24th congress of the Collegium Internationale Neuro-Psychopharmacologicum.
In a survey of about 500 physicians conducted by Dr. Nierenberg and his associates, most said they start to grow impatient when a patient does not respond to an antidepressant after 4 weeks of treatment. Many also noted that they would boost the patient's dosage after 4 weeks without a response, but few data exist to show that this helps, said Dr. Nierenberg, a psychiatrist at Harvard University and Massachusetts General Hospital in Boston.
The results from several studies have shown that it may take several weeks for a depressed patient to show an initial response to an SSRI. One study, done by Dr. Nierenberg and associates about 10 years ago, involved more than 300 patients and focused on how quickly patients could be flagged as nonresponders to a regimen of 20 mg of fluoxetine daily. Patients were considered responders if their depression symptoms improved by at least a 20%.
Patients who had not responded to this treatment after 2 weeks still had a 36% chance of responding after 8 full weeks of treatment, but as the period without a response grew, chances fell that the patient would eventually respond after 8 weeks. ...
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