The DEPRE'5 study : Pragmatic, multicentre, five-arm, parallel-group randomised controlled trial with blinded assessment to compare treatment strategies in major depression after a failed selective serotonin reuptake inhibitor treatment
Pérez Solà, Víctor (Institut Hospital del Mar d'Investigacions Mediques)
Puigdemont, Dolors (Institut de Recerca Sant Pau)
de Diego-Adeliño, Javier (Institut de Recerca Sant Pau)
Elices, M. (Institut Hospital del Mar d'Investigacions Mèdiques)
Leal-Leturia, Itziar (Instituto de Investigación Sanitaria Hospital Universitario de La Princesa (Madrid))
Cabello, Maria (Instituto de Investigación Sanitaria Hospital Universitario de La Princesa (Madrid))
Rodriguez-Jimenez, Roberto (Instituto de Investigación Hospital 12 de Octubre (Madrid))
Álvarez-Mon, Miguel Ángel (Hospital Universitario Infanta Leonor)
García-Fernández, Lorena (Hospital Universitario San Juan de Alicante)
Aguilar García-Iturrospe, Eduardo José (Hospital Clínic Universitari (València))
Escartí, María José (Hospital Clínic Universitari (València))
Montejo, Angel L (Hospital Clínico Universitario (Salamanca))
Montes, José Manuel (Hospital Universitario Ramón y Cajal (Madrid))
Usall, Judith (Parc sanitari Sant Joan de Déu)
Gallego-Nogueras, Ascensión (Instituto de Investigación Biomédica de Salamanca)
Lujan, Elena (Hospital Universitario Del Sureste (Madrid))
López-Carrilero, Raquel (Parc Sanitari Sant Joan de Déu)
González-Pinto, Ana (Arabako Unibertsitate Ospitalea (Vitoria, País Basc))
Ortiz-Jauregui, Agurtzane (Arabako Unibertsitate Ospitalea (Vitoria, País Basc))
Blanch, Jordi (Hospital Clínic i Provincial de Barcelona)
Urretavizcaya, Mikel (Hospital Universitari de Bellvitge)
Colom, Francesc 1971- (Institut Hospital del Mar d'Investigacions Mèdiques)
Garcia-Campayo, Javier (Hospital Universitario Miguel Servet (Saragossa))
Ayuso-Mateos, Jose Luis (Instituto de Investigación Sanitaria Hospital Universitario de La Princesa (Madrid))
Universitat Autònoma de Barcelona

Data:	2025
Resum:	Background Selective serotonin reuptake inhibitors (SSRIs) are the first-line treatment for major depressive disorder (MDD), but initial outcomes can be modest. Aims To compare SSRI dose optimisation with four alternative second-line strategies in MDD patients unresponsive to an SSRI. Method Of 257 participants, 51 were randomised to SSRI dose optimisation (SSRI-Opt), 46 to lithium augmentation (SSRI+Li), 48 to nortriptyline combination (SSRI+NTP), 55 to switch to venlafaxine (VEN) and 57 to problem-solving therapy (SSRI+PST). Primary outcomes were week-6 response/remission rates, assessed by blinded evaluators using the 17-item Hamilton Depression Rating Scale (HDRS-17). Changes in HDRS-17 scores, global improvement and safety outcomes were also explored. EudraCT No. 2007-002130-11. Results Alternative second-line strategies led to higher response (28. 2% v. 14. 3%, odds ratio = 2. 36 [95% CI 1. 0-5. 6], p = 0. 05) and remission (16. 9% v. 12. 2%, odds ratio = 1. 46, [95% CI 0. 57-3. 71], p = 0. 27) rates, with greater HDRS-17 score reductions (-2. 6 [95% CI -4. 9 to -0. 4], p = 0. 021]) than SSRI-Opt. Significant/marginally significant effects were only observed in both response rates and HDRS-17 decreases for VEN (odds ratio = 2. 53 [95% CI 0. 94-6. 80], p = 0. 067; HDRS-17 difference: -2. 7 [95% CI -5. 5 to 0. 0], p = 0. 054) and for SSRI+PST (odds ratio = 2. 46 [95% CI 0. 92 to 6. 62], p = 0. 074; HDRS-17 difference: -3. 1 [95% CI -5. 8 to -0. 3], p = 0. 032). The SSRI+PST group reported the fewest adverse effects, while SSRI+NTP experienced the most (28. 1% v. 75%; p < 0. 01), largely mild. Conclusions Patients with MDD and insufficient response to SSRIs would benefit from any other second-line strategy aside from dose optimisation. With limited statistical power, switching to venlafaxine and adding psychotherapy yielded the most consistent results in the DEPRE'5 study.
Nota:	Altres ajuts: acords transformatius de la UAB
Drets:	Aquest document està subjecte a una llicència d'ús Creative Commons. Es permet la reproducció total o parcial, la distribució, la comunicació pública de l'obra i la creació d'obres derivades, fins i tot amb finalitats comercials, sempre i quan es reconegui l'autoria de l'obra original.
Llengua:	Anglès
Document:	Article ; recerca ; Versió publicada
Matèria:	Major depressive disorder ; Treatment resistant depression ; Selective serotonin reuptake inhibitors ; Antidepressants ; Psychotherapy
Publicat a:	The British journal of psychiatry, 2025 , ISSN 1472-1465

DOI: 10.1192/bjp.2025.13
PMID: 40530754

8 p, 636.0 KB

El registre apareix a les col·leccions:
Documents de recerca > Documents dels grups de recerca de la UAB > Centres i grups de recerca (producció científica) > Ciències de la salut i biociències > Institut de Recerca Sant Pau
Articles > Articles de recerca
Articles > Articles publicats