Pharmacopsychiatry 2008; 41(3): 100-105
DOI: 10.1055/s-2008-1058103
Original Paper

© Georg Thieme Verlag KG Stuttgart · New York

Treatment of Seasonal Affective Disorder with Duloxetine: An Open-Label Study

E. Pjrek 1 , M. Willeit 1 , N. Praschak-Rieder 1 , A. Konstantinidis 1 , H. V. Semlitsch 1 , S. Kasper 1 , D. Winkler 1
  • 1Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria
Further Information

Publication History

received 08.08.2007 revised 09.10.2007

accepted 03.12.2007

Publication Date:
19 May 2008 (online)

Abstract

Objective: The aim of this observational study was to evaluate the effects of duloxetine in the treatment of seasonal affective disorder (SAD).

Patients and Methods: 26 SAD patients were treated with open-label duloxetine 60-120 mg per day over 8 weeks. Ratings included the Structured Interview Guide for the Hamilton Depression Rating Scale (SAD version; SIGH-SAD) and the Clinical Global Impression (CGI). To estimate treatment effects on social functioning in SAD we employed the Social Adaptation Self Evaluation Scale (SASS), the Sheehan Disability Scale (SDS), and assessments of days lost due to illness and days with reduction in productivity.

Results: Duloxetine led to a significant improvement (p<0.001) of SIGH-SAD, CGI severity, SASS, and SDS scores. Days lost due to illness and days with reduction in productivity were significantly diminished during treatment (p<0.001). Treatment with duloxetine over 8 weeks yielded a response rate (SIGH-SAD <50% of baseline value) of 80.8% and a remission rate (SIGH-SAD <8) of 76.9% in the intention to treat sample. The drop-out rate due to side effects was 15.4%.

Conclusions: Our preliminary results indicate that duloxetine might be effective and able to ameliorate the negative social consequences of SAD.

References

  • 1 American Psychiatric Association .Diagnostic and Statistical Manual of Mental Disorder, 4th edition, text revision (DSM-IV-TR). Washington, DC: American Psychiatric Press 2000
  • 2 Arnold LM, Rosen A, Pritchett YL, D'Souza DN, Goldstein DJ, Iyengar S. et al . A randomized, double-blind, placebo-controlled trial of duloxetine in the treatment of women with fibromyalgia with or without major depressive disorder.  Pain. 2005;  119 5-15
  • 3 Bech P, Allerup P, Gram LF, Reisby N, Rosenberg R, Jacobsen O. et al . The Hamilton depression scale. Evaluation of objectivity using logistic models.  Acta Psychiatr Scand. 1981;  63 290-299
  • 4 Bech P, Kajdasz DK, Porsdal V. Dose-response relationship of duloxetine in placebo-controlled clinical trials in patients with major depressive disorder.  Psychopharmacology. 2006;  188 273-280
  • 5 Berto P, D'Ilario D, Ruffo P, Virgilio R Di, Rizzo F. Depression: cost-of-illness studies in the international literature, a review.  J Ment Health Policy Econ. 2000;  3 3-10
  • 6 Bosc M, Dubini A, Polin V. Development and validation of a social functioning scale, the Social Adaptation Self-evaluation Scale.  Eur Neuropsychopharmacol. 1997;  7 ((Suppl 1)) 57-70 , , discussion 71-73
  • 7 Bundesgesetzblatt für die Republik Österreich . Bundesgesetz über die Herstellung und das Inverkehrbringen von Arzneimitteln (Arzneimittelgesetz). 1983;  , BGBl. Nr. 185/1983
  • 8 Bymaster FP, Lee TC, Knadler MP, Detke MJ, Iyengar S. The dual transporter inhibitor duloxetine: a review of its preclinical pharmacology, pharmacokinetic profile, and clinical results in depression.  Curr Pharm Des. 2005;  11 1475-1493
  • 9 Cohen S, Kuhn KU, Bender S, Erfurth A, Gastpar M, Murafi A. et al . Sexual impairment in psychiatric inpatients: focus on depression.  Pharmacopsychiatry. 2007;  40 58-63
  • 10 Duschek S, Schandry R, Hege B. Soziale Aktivität Selbstbeurteilungs-Skala (SASS). Diagnostik sozialer Funktionsstörungen bei depressiven Störungen. Göttingen: Beltz Test GmbH 2003
  • 11 First MB, Spitzer RL, Gibbon M, Williams JB. Structured clinical interview for DSM-IV axis I disorders - patient edition. SCID-I/P, version 2.0 New York, NY: New York State Psychiatric Institute, Biometric Research Department 1996
  • 12 Gahimer J, Wernicke J, Yalcin I, Ossanna MJ, Wulster-Radcliffe M, Viktrup L. A retrospective pooled analysis of duloxetine safety in 23,983 subjects.  Curr Med Res Opin. 2007;  23 175-184
  • 13 Gräfe K. Sheehan Disability Scale (SDS). In: Hoyer J, Margraf J (Eds). Angstdiagnostik. Grundlagen und Testverfahren. Berlin: Springer 2003: 158-160
  • 14 Guy W. ECDEU assessment manual for psychopharmacology. US Department of Health, Education and Welfare publication (ADM) 76-338. Rockville, MD: National Institute of Mental Health 1976
  • 15 Haberfellner E. A review of the assessment of antidepressant-induced sexual dysfunction used in randomized, controlled clinical trials.  Pharmacopsychiatry. 2007;  40 173-182
  • 16 Hamilton M. Development of a rating scale for primary depressive illness.  Br J Soc Clin Psychol. 1967;  6 278-296
  • 17 Harro J, Oreland L. Depression as a spreading adjustment disorder of monoaminergic neurons: a case for primary implication of the locus coeruleus.  Brain Res Rev. 2001;  38 79-128
  • 18 Hauptverband der Österreichischen Sozialversicherungsträger .Handbuch der Österreichischen Sozialversicherung 2002. Wien: Österreichische Sozialversicherung 2002
  • 19 Hilger E, Willeit M, Praschak Rieder N, Stastny J, Neumeister A, Kasper S. Reboxetine in seasonal affective disorder: an open trial.  Eur Neuropsychopharm. 2001;  11 1-5
  • 20 Hudson JI, Wohlreich MM, Kajdasz DK, Mallinckrodt CH, Watkin JG, Martynov OV. Safety and tolerability of duloxetine in the treatment of major depressive disorder: analysis of pooled data from eight placebo-controlled clinical trials.  Hum Psychopharmacol. 2005;  20 327-341
  • 21 Karpa KD, Cavanaugh JE, Lakoski JM. Duloxetine pharmacology: profile of a dual monoamine modulator.  CNS Drug Rev. 2002;  8 361-376
  • 22 Kasper S. Jahreszeit und Befindlichkeit in der Allgemeinbevölkerung. Eine Mehrebenenuntersuchung zur Epidemiologie, Biologie und therapeutischen Beeinflußbarkeit (Lichttherapie) saisonaler Befindlichkeitsschwankungen. Monographien aus dem Gesamtgebiet der Psychiatrie, Bd. 66. Berlin, Heidelberg, New York, Tokyo: Springer 1991
  • 23 Kasper S, Rogers LBS, Yancey A, Schulz PM, Skwerer RG, Rosenthal NE. Phototherapy in individuals with and without subsyndromal seasonal affective disorder.  Arch Gen Psychiatry. 1989;  46 837-844
  • 24 Lam RW, Levitt AJ, Levitan RD, Enns MW, Morehouse R, Michalak EE. et al . The Can-SAD study: a randomized controlled trial of the effectiveness of light therapy and fluoxetine in patients with winter seasonal affective disorder.  Am J Psychiatry. 2006;  163 805-812
  • 25 Leon AC, Olfson M, Portera L, Farber L, Sheehan DV. Assessing psychiatric impairment in primary care with the Sheehan Disability Scale.  Int J Psychiatry Med. 1997;  27 93-105
  • 26 Lingjærde O, Ahlfors UG, Bech P, Dencker SJ, Elgen K. The UKU side effect rating scale. A new comprehensive rating scale for psychotropic drugs and a cross-sectional study of side effects in neuroleptic-treated patients.  Acta Psychiatr Scand. 1987;  76 ((Suppl 334)) 1-100
  • 27 Mariappan P, Alhasso A, Ballantyne Z, Grant A, N’Dow J. Duloxetine, a serotonin and noradrenaline reuptake inhibitor (SNRI) for the treatment of stress urinary incontinence: a systematic review.  Eur Urol. 2007;  51 67-74
  • 28 Martiny K, Lunde M, Simonsen C, Clemmensen L, Poulsen DL, Solstad K. et al . Relapse prevention by citalopram in SAD patients responding to 1 week of light therapy. A placebo-controlled study.  Acta Psychiatr Scand. 2004;  109 230-234
  • 29 Modell JG, Rosenthal NE, Harriett AE, Krishen A, Asgharian A, Foster VJ. et al . Seasonal affective disorder and its prevention by anticipatory treatment with bupropion XL.  Biol Psychiatry. 2005;  58 658-667
  • 30 Moscovitch A, Blashko CA, Eagles JM, Darcourt G, Thompson C, Kasper S. et al . A placebo-controlled study of sertraline in the treatment of outpatients with seasonal affective disorder.  Psychopharmacology (Berl). 2004;  171 390-397
  • 31 Neumeister A, Turner EH, Matthews JR, Postolache TT, Barnett RL, Rauh M. et al . Effects of tryptophan depletion vs. catecholamine depletion in patients with seasonal affective disorder in remission with light therapy.  Arch Gen Psychiatry. 1998;  55 524-530
  • 32 Neumeister A, Willeit M, Praschak-Rieder N, Asenbaum S, Stastny J, Hilger E. et al . Dopamine transporter availability in symptomatic depressed patients with seasonal affective disorder and healthy controls.  Psychol Med. 2001;  31 1467-1473
  • 33 Pendse BP, Ojehagen A, Engstrom G, Traskman-Bendz L. Social characteristics of seasonal affective disorder patients: comparison with suicide attempters with non-seasonal major depression and other mood disorder patients.  Eur Psychiatry. 2003;  18 36-39
  • 34 Pjrek E, Winkler D, Konstantinidis A, Willeit M, Praschak-Rieder N, Kasper S. Agomelatine in the treatment of seasonal affective disorder.  Psychopharmacology. 2007;  190 575-579
  • 35 Pjrek E, Winkler D, Stastny J, Konstantinidis A, Heiden A, Kasper S. Bright light therapy in seasonal affective disorder - does it suffice?.  Eur Neuropsychopharmacol. 2004;  14 347-351
  • 36 Pjrek E, Winkler D, Stastny J, Praschak-Rieder N, Willeit M, Kasper S. Escitalopram in seasonal affective disorder: results of an open trial.  Pharmacopsychiatry. 2007;  40 20-24
  • 37 Rosenthal NE, Bradt GH, Wehr TA. Seasonal Pattern Assessment Questionnaire. Washington, DC: National Institute of Mental Health 1987
  • 38 Rosenthal NE, Sack DA, Gillin JC, Lewy AJ, Goodwin FK, Davenport Y. et al . Seasonal affective disorder: a description of the syndrome and preliminary findings with light therapy.  Arch Gen Psychiatry. 1984;  41 72-80
  • 39 Ruhrmann S, Kasper S, Hawellek B, Martinez B, Hoflich G, Nickelsen T. et al . Effects of fluoxetine versus bright light in the treatment of seasonal affective disorder.  Psychol Med. 1998;  28 923-933
  • 40 Rynn M, Russell J, Erickson J, Detke MJ, Ball S, Dinkel J. et al . Efficacy and safety of duloxetine in the treatment of generalized anxiety disorder: a flexible-dose, progressive-titration, placebo-controlled trial.  Depress Anxiety. 2007;  , ; doi 10.1002/da.20271
  • 41 Sheehan DV. The Anxiety Disease. New York: Charles Scribner's Sons 1983
  • 42 Smith TR. Duloxetine in diabetic neuropathy.  Expert Opin Pharmacother. 2006;  7 215-223
  • 43 Sobocki P, Jonsson B, Angst J, Rehnberg C. Cost of depression in Europe.  J Ment Health Policy Econ. 2006;  9 87-98
  • 44 Spencer CM, Wilde MI. Milnacipran. A review of its use in depression.  Drugs. 1998;  56 405-427
  • 45 SPSS Inc .SPSS 12.0 for Windows. Release 12.0 Chicago, IL, USA 1989-2003
  • 46 , Statistik Austria. Statistisches Jahrbuch. http://www.statistik.at 2003; 
  • 47 Wellington K, Perry CM. Venlafaxine extended-release: a review of its use in the management of major depression.  CNS Drugs. 2001;  15 643-669
  • 48 Wheatley D. Hypericum in seasonal affective disorder (SAD).  Curr Med Res Opin. 1999;  15 33-37
  • 49 Williams JBW, Link MJ, Rosenthal NE, Amira L, Terman M. Structured Interview Guide for the Hamilton Depression Rating Scale - Seasonal Affective Disorder Version, 2002 rev. New York, NY: New York State Psychiatric Institute 2002
  • 50 Winkler D, Pjrek E, Iwaki R, Kasper S. The treatment of seasonal affective disorder.  Expert Rev Neurother. 2006;  6 1039-1048
  • 51 Winkler D, Pjrek E, Konstantinidis A, Stastny J, Kasper S. Seasonal affective disorder - pathophysiology and clinical management.  Acta Psychiatr Belg. 2005;  105 141-148
  • 52 Wohlreich MM, Mallinckrodt CH, Prakash A, Watkin JG, Carter WP. Duloxetine for the treatment of major depressive disorder: safety and tolerability associated with dose escalation.  Depress Anxiety. 2007;  24 41-52

Correspondence

E. PjrekMD 

Department of Psychiatry and Psychotherapy

Medical University of Vienna

Währinger Gürtel 18-20

1090 Vienna

Austria

Phone: +43/1/40400 35 68

Fax: +43/1/40400 30 99

Email: edda.pjrek@meduniwien.ac.at

    >