Fluoxetine in tricyclic refractory depression in adolescents

Abstract

In an open cross-over trial, six hospitalized adolescents (15–18 years) with a DSM-III-R diagnosis of major depression, who had failed to respond to a trial of tricyclic antidepressant (TCA) with or without lithium augmentation, were treated with fluoxetine. Fluoxetine treatment (20–60 mg/day) was associated with a reduction in depression severity after 4 weeks, as measured by Hamilton Rating Scale for Depression. The Hamilton Rating Scale for Depression scores (HRSD) reduced significantly after 4 weeks, from 15.8 ± 2.3 to 8.1 ± 3.4 (Z = 2.2, P < 0.02; Wilcoxin signed rank test). Fluoxetine was well tolerated and no subject required discontinuation of medication. One patient became hypomanic on 60 mg/day but responded to dose reduction. Data suggest that, as in the adult age group, there may be a subgroup of TCA non-responsive depressed adolescents who respond to fluoxetine. Shortcomings of the present report are a small number of subjects, open nature of study design, and absence of standardized treatment before commencing trial of fluoxetine. Findings of this report suggest that controlled trials using a placebo-controlled design and involving a larger number of subjects are indicated. Depression 2:287–291 (1994/1995). © 1995 Wiley-Liss, Inc.