A 12-week regimen of fluoxetine appears to be successful in ameliorating
depressive symptoms in patients who do not meet criteria for major depressive
But improvement in psychosocial functioning with fluoxetine may take longer
than 12 weeks in these patients, according to a study in the October
American Journal of Psychiatry.
The study suggests that a widely accepted assumption about the usefulness
of pharmacologic intervention in subacute or "minor" depression
may need to be reversed. That assumption rests on a 1988 study by Paykel and
colleagues showing that patients with minor depression did not respond
significantly better to the antidepressant amitriptyline than to placebo. It
was published in the January 1988 Pharmacopsychiatry.
The new study was conducted by Lewis Judd, M.D., chair of the department of
psychiatry at the University of California, San Diego, and researchers at four
other institutions and Eli Lilly and Co. in Indianapolis.
It was supported in part by grants from the National Institute of Mental
Health, the Roher Fund of the University of California, San Diego, and an
unrestricted investigator-initiated contract from Eli Lilly and Co., which
manufactures the Prozac brand of fluoxetine.
In the study, 162 patients with minor depressive disorder were randomly
assigned to receive fluoxetine or placebo in a 12-week, double-blind study; of
those, 59 in each treatment group completed the study. At baseline, all
patients were mildly to moderately depressed with a corresponding degree of
Over the 12-week period, the fluoxetine group showed significantly greater
improvement in scores on the 30-item clinician-rated Inventory of Depressive
Symptomatology, the 17-item and 21-item Hamilton Depression Rating Scale, the
Beck Depression Inventory, and the Clinical Global Impression severity
However, the fluoxetine group did not improve more than the placebo group
on any of three measures of psychosocial functioning. Those measures included
the Global Assessment of Functioning (GAF) Scale and the social function and
emotional role function scores on the Medical Outcomes Study 36-Item Short
Form Health Survey. But secondary statistical analysis showed that the rate of
improvement—though not the absolute score—on the GAF measure was
significantly greater in the fluoxetine group than in the placebo group.
"Findings from this rigorously controlled study indicate that minor
depressive disorder can be treated successfully with fluoxetine, but full
normalization of associated psychosocial function may require longer
treatment," the authors wrote. "It is also likely that other SSRIs
or newer non-SSRI antidepressants might produce similar results under similar
The study, "Randomized, Placebo-Controlled Trial of Fluoxetine
for Acute Treatment of Minor Depressive Disorder," is posted online at<http://ajp.psychiatryonline.org/cgi/content/full/161/10/1864>.▪
Am J Psychiatry