Efficacy Of Paroxetine In Patients Research Articles

Association of 2 Neurotrophic Factor Polymorphisms With Efficacy of Paroxetine in Patients With Major Depressive Disorder in a Chinese Population

To evaluate the influence of the single nucleotide polymorphism (SNP) rs 6265 in the brain-derived neurotrophic factor (BDNF) gene and 21 SNPs of the glial cell line-derived neurotrophic factor (GDNF) gene on the efficacy of paroxetine in patients with major depressive disorder (MDD). Genotyping for BDNF and GDNF polymorphisms was performed in 298 patients with MDD who started 20 mg paroxetine per day and had their plasma concentrations measured after 6 weeks. The SNPs were selected from the HapMap Chinese ethnic group and literature reports. Changes in the severity of MDD were assessed with the Hamilton Depression Rating Scale (HAM-D) at baseline and at a 6-week follow-up. Paroxetine plasma concentration was measured using high-performance liquid chromatography with fluorescence detection. The Sequenom MassArray system was used for genotyping. At the 6-week follow-up, 219 of the 298 patients (73.5%) were responders and 79 patients (26.5%) were nonresponders to paroxetine treatment. The lower threshold concentration of paroxetine for response was 50 ng/mL, and a linear relationship was found between paroxetine plasma concentration and clinical response. The allele types for the SNPs rs 6265 (P < 0.001), rs 2973049 (P = 0.005), and rs 2216711 (P = 0.006) demonstrated significant associations with paroxetine treatment remission at week 6. Genetic variants in the BDNF and GDNF regions may be indicators of treatment response to paroxetine in patients with MDD.

Comparison of Paroxetine and Maprotiline in Minor Depression

Whilst the efficacy of paroxetine has been demonstrated in MDD, its clinical utility in minor depression has not been established. This study assesses the antidepressant efficacy of paroxetine in patients meeting RDC criteria for minor depression. All patients scored 13 points on the 17-item Hamilton Depression Rating Scale (HAMD) at baseline. After a 3 day washout period, patients were randomised to receive paroxetine 20–40mg/day or maprotiline 100-150mg/day, dose being titrated according to clinical response after 3 weeks treatment at the lower doses. Assessments conducted at baseline (day 0) and at weekly intervals for 6 weeks included the 17-item HAMD, the Montgomery-Asberg Depression Rating Scale (MADRS), and the physicians Clinical Global Impression (CGI). 245 patients (126 paroxetine and 119 maprotiline) were evaluable on an intent to treat basis. The two groups were well matched on all major demographic variables. For the changes from baseline on the HAMD total, the paroxetine group had significantly greater mean reductions at weeks 3-6 and end-point (p≤ 0.04). This result was reinforced by the numbers of patients achieving a 50% reduction in HAMD total at weeks 4 to 6: week 4 - 79% paroxetine, 67% maprotiline; week 6: −91% paroxetine, 80% maprotiline. The robustness of these findings was further underscored by similar results for the MADRS and the CGI. These results indicate the superior efficacy of paroxetine compared to maprotiline in minor depression.