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Am J Psychiatry 1997; 154:963-969
Copyright © 1997 by American Psychiatric Association
Fluoxetine and norfluoxetine plasma concentrations in major depression: a multicenter study
JD Amsterdam, J Fawcett, FM Quitkin, FW Reimherr, JF Rosenbaum, D Michelson, M Hornig-Rohan and CM Beasley
Depression Research Unit, University of Pennsylvania Medical Center, Philadelphia, USA.
OBJECTIVE: Prior studies examining the relationship between fluoxetine
plasma concentrations and response in major depression have either found no
relationship between plasma concentration and response or suggested a
curvilinear relationship with a therapeutic window. To elucidate this
relationship, plasma concentrations of fluoxetine, norfluoxetine,
fluoxetine plus norfluoxetine, and fluoxetine/norfluoxetine ratio were
compared to therapeutic response. METHOD: A total of 839 patients (577
women, 262 men; mean age = 40 [SD = 11] with a DSM-III-R diagnosis of major
affective disorder who were in the course of either depression or bipolar
disorder not otherwise specified and had a minimum baseline score of 16 on
the 17-item Hamilton Depression Rating Scale were initially treated.
Response was defined as follows: 1) nonresponders had less that a 50% or
more reduction from baseline Hamilton depression score, 2) nonremitting
responders had a 50% or more reduction from baseline Hamilton depression
score but a final score higher than 7, and 3) remitters had a final
Hamilton Depression score of 7 or lower. Plasma fluoxetine and
norfluoxetine concentrations were measured after 8 weeks of fixed-dose
treatment of 20 mg/day. RESULTS: Plasma concentration data were available
from 615 patients. Plasma concentration were similar in responders, both
remitting and nonremitting (N = 411), and nonresponders (N = 204) for
fluoxetine concentrations, for norfluoxetine concentrations, as well as for
the sum of fluoxetine and norfluoxetine and for the ratio of fluoxetine to
norfluoxetine. No apparent relationship was observed between plasma drug
concentration and clinical response. CONCLUSION: Plasma concentrations of
fluoxetine and norfluoxetine do not appear to be related to clinical
outcome and should not be used to make treatment decisions.
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No Relation Between Plasma Fluoxetine and Clinical Response
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1997(901):
18 - 18.
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NO RELATIONSHIP BETWEEN PLASMA FLUOXETINE LEVEL AND CLINICAL RESPONSE
Journal Watch (General),
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1997(722):
4 - 4.
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