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Tachyphylaxis in unipolar major depressive disorder
David A Solomon1, Andrew C Leon, Timothy I Mueller
1Department of Psychiatry and Human Behavior, Brown University, 593 Eddy Street, Providence, RI 02903, USA. DASolomon@Lifespan.org
The Journal of Clinical Psychiatry
|March 16, 2005
Summary
Major depressive disorder often recurs even with maintenance pharmacotherapy. This study found that 25% of treatment intervals showed tachyphylaxis, particularly in melancholic depression, indicating a need for new strategies.
Area of Science:
- Psychiatry
- Pharmacology
- Clinical Research
Background:
- Major depressive disorder (MDD) is a recurrent illness.
- Maintenance pharmacotherapy aims to prevent depressive episodes.
- This study investigates recurrence of MDD despite maintenance treatment, a phenomenon termed tachyphylaxis.
Purpose of the Study:
- To describe the recurrence of major depressive disorder (MDD) during maintenance pharmacotherapy.
- To identify factors associated with tachyphylaxis in MDD patients.
Main Methods:
- Analysis of 103 subjects from the NIMH Collaborative Depression Study, followed for up to 20 years.
- Inclusion criteria: diagnosis of unipolar MDD, recovery from an episode, and subsequent maintenance pharmacotherapy.
- Mixed-effects logistic regression used to analyze sociodemographic and clinical variables associated with tachyphylaxis.
Main Results:
- 171 maintenance treatment intervals were analyzed.
- Tachyphylaxis occurred in 43 (25%) of these intervals.
- Melancholic (endogenous) subtype of MDD significantly increased the risk of tachyphylaxis.
Conclusions:
- Major depression recurrence is common even with maintenance pharmacotherapy.
- Current prophylactic strategies may be insufficient for a significant number of patients.
- Further research into recurrence mechanisms is needed to develop improved treatment strategies.