Reboxetine adjunct for partial or nonresponders to antidepressant treatment

Background: To investigate the usefulness of the combination therapy with two antidepressants from different pharmacological families in treatment-resistant depressive patients. Methods: In this prospective 6 weeks open-label study, we assessed the effectiveness of the addition of reboxetine to 61 depressive patients that had previously not responded, or had done so only in a partial way, to conventional treatment, in monotherapy, with selective serotonin reuptake inhibitors (SSRIs), venlafaxine or mirtazapine. Data were analyzed on an intent-to-treat basis, using the last-observation-carried-forward (LOCF) method. Results: Mean decrease on the 21-item Hamilton Depression Rating Scale (HDRS) score was 48.9% and on the Clinical Global Impressions Scale (CGI), 38.9%. At the end of the treatment, 62.3% of the patients were evaluated as improvement (CGI<4), 54.1% as responders (HDRS≤50%) and 45.9% in remission (HDRS≤10). No serious side effects were observed during combination therapy, being more frequent increased sweating (8.2%) and dry mouth (6.6%). Conclusions: These findings suggest that the strategy of combination with reboxetine may be an effective and well-tolerated tool in treatment-resistant patients who have failed to adequately respond to monotherapy with SSRIs, venlafaxine or mirtazapine.