Rapid
antidepressant effect with the combined
treatment by sulpiride and paroxetine
The
delayed onset of action of antidepressants
remains a problem for patients with major
depressive disorder. It is all the more
important to relieve depressive symptoms early
since they tend to be more severe at the
beginning of the treatment. Fast action should
therefore lead to a better treatment compliance.
Sulpiride, a dopamine D2 receptor
antagonist, has been shown to have a faster
antidepressant effect at low doses than
classical compounds. A study examined the
efficacy and rapidity of action of sulpiride
associated to paroxetine in comparison with
paroxetine alone.
In a 12-week open-label trial, 41 patients with
major depressive disorder were randomly assigned
to 10 - 40 mg/d of paroxetine or 10 - 40 mg/d of
paroxetine plus 100 mg/d of sulpiride.
Assessment of efficacy used the
Montgomery-Asberg Depression Rating Scale
(MADRS), the 17-item Hamilton Rating Scale for
Depression (HRSD), the Zung self-rating
Depression Scale (ZDS), and adverse events were
monitored.
The completion rate was 82.5% (33/41 patients).
Both treatments showed significant improvement
for the MADRS, HRSD, and ZDS total scores.
However, in the combined treatment group the
change in the total scores of the three scales
was significantly superior to the monotherapy
group from week 1 through to the end of the
study. Significantly shorter median times to
response were observed in the responders of the
combination treatment (2 weeks) than in those of
the monotherapy (6 weeks) . There was no
difference in the emergence of side effects in
both groups.
This study has shown the utility of combining
sulpiride with paroxetine for treating patients
with major depressive disorder. Not only was the
efficacy of the combined treatment superior at
the study end point but the time to achieve
response was significantly more rapid. Uchida
H, Takeuchi H, Suzuki T, Nomura K, Watanabe K,
Kashima H. Combined treatment with sulpiride and
paroxetine for accelerated response in patients
with major depressive disorder. J Clin
Psychopharmacol 2005, 25:545-551.