No abstract

Clonazepam augmentation of fluoxetine was superior to fluoxetine alone in the first 3 weeks of treatment. This strategy may reduce suffering during early SSRI treatment, may partially suppress SSRI side effects, may increase compliance, and could possibly reduce the risk of suicide.

No abstract

Pain centers meet success in dealing with many cases of chronic pain which had been refractory to other therapies. Unfortunately, about one-fourth of all patients who initially do well begin to deteriorate shortly after completion, and within a few months have regressed to pre-treatment levels. In an effort to understand the causes of this regression, the authors surveyed patients who completed the program in 1977 by means of mail questionnaire. The 25 most successful patients were contrasted with an equal cohort of failures (i.e., patients who had met with initial success and subsequent regression). Correlations were also performed among indices of change and other variables. The failure group demonstrated less incentive for maintaining their gains, most continuing to receive financial compensation for their pain. Differences in attitude were revealed, with the failure group more likely to assume a dependent, passive stance. Depression was more characteristic of the failure group and may be causative with respect to deterioration. Most strinkingly, it appeared that the failure group had done little to change their environments, and continued to find reinforcement for pain behavior following discharge. The survey suggests the need for changes in the area of employment for injured workers, as well as further research in attitude measurement and attitude change. More aggressive treatment of depression might reduce the tendency toward regression, as would increased effort to change family dynamics that reward the patient for overt suffering.

Anxious depression, defined as major depressive disorder (MDD) accompanied by high levels of anxiety, seems to be both common and difficult to treat, with antidepressant monotherapy often yielding modest results. We sought to examine the relative benefits of antidepressant-anxiolytic cotherapy versus antidepressant monotherapy for patients with anxious depression versus without anxious depression. We conducted a post-hoc analysis of an existing dataset (N=80), from a 3-week, randomized, double-blind trial which demonstrated cotherapy with fluoxetine and clonazepam to result in superior efficacy than fluoxetine monotherapy in MDD. The present analysis involved examining whether anxious depression status served as a predictor and moderator of symptom improvement. Anxious depression status was not found to predict symptom improvement, or serve as a moderator of clinical improvement to cotherapy versus monotherapy. However, the advantage in remission rates in favor of cotherapy versus monotherapy was, numerically, much larger for patients with anxious depression (32.2%) than it was for patients without anxious MDD (9.7%). The respective number needed to treat statistic for these two differences in response rates were, approximately, one in three for patients with anxious depression versus one in 10 for patients without anxious depression. The efficacy of fluoxetine-clonazepam cotherapy compared with fluoxetine monotherapy was numerically but not statistically enhanced for patients with anxious depression than those without anxious depression.