Abstract
Objective
To compare the efficacy of imipramine and fluvoxamine in inpatients from two centers suffering from a depressive disorder according to DSM IV criteria.
Methods
The study included 141 patients with a depressive disorder according to DSM IV criteria. After a drug-free and placebo run-in period of 1 week, patients were randomized to imipramine or fluvoxamine; doses of both drugs were adjusted to a predefined target blood level. Efficacy was evaluated 4 weeks after attaining predefined adequate plasma level.
Results
The mean age of the study group (47 males, 94 females) was 51.8 (range 19–65) years. Of these 141 patients, 56 had episode duration longer than 1 year, 48 had mood congruent psychotic features, and 138 patients received medication. Seven patients did not complete the medication trial. The total number of patients using concurrent medication was 12/138 (8.6%). On the primary outcome criteria patients on imipramine improved significantly better on the change of illness severity score of the CGI (χ2 exact trend test=4.089, df=1, P=0.048). There was no significant difference in 50% or more reduction on the HRSD, the other primary outcome criterion. On the secondary outcome criteria the mean reduction of the HRSD scores was significantly larger in the imipramine group than in the fluvoxamine group (mean difference=3.1, standard error (SE)=1.4, t=2.15, df=136, P=0.033). There was no significant difference in the number of patients with an HRSD ≤7 at the final evaluation.
Conclusions
In depressed inpatients imipramine is more efficacious than fluvoxamine. Both drugs were well tolerated by all patients.
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Acknowledgements
This study was supported by an unconditional grant from Solvay Pharma, The Netherlands, the manufacturer of fluvoxamine. We also thank the pharmacy department of the Erasmus MC for the preparation of the medication and the determination of the plasma levels and assistance in dosing the antidepressants.
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van den Broek, W.W., Birkenhäger, T.K., Mulder, P.G.H. et al. A double-blind randomized study comparing imipramine with fluvoxamine in depressed inpatients. Psychopharmacology 175, 481–486 (2004). https://doi.org/10.1007/s00213-004-1853-3
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DOI: https://doi.org/10.1007/s00213-004-1853-3