Objectives: The aim of this study is to evaluate the efficacy and tolerability of sertraline in patients with major depression who have failed to respond to an adequate trial of moclobemide.
Method: Sixty-three patients with major depression who had discontinued moclobemide within the last 6 weeks due to lack of efficacy were recruited from multiple psychiatric services in Victoria and Queensland. After a wash-out period, patients were treated with sertraline 50 mg once daily for 4 weeks. If there was an insufficient response, the dose was titrated upwards to a maximum of 200 mg/day, with 2 weeks at each dosage level. By the end of the study, patients had received a fixed dose of sertraline for 8 weeks. The main outcome measures were the 17-item Hamilton Rating Scale for Depression (HAMD) and Clinical Global Impression (CGI) scales. Secondary outcome measures included the Montgomery-Asberg Depression Rating Scale (MADRS) and Beck Depression Inventory (BDI).
Results: Of the 62 intention-to-treat patients enrolled, 48 (77%) responded to sertraline (i.e. experienced ≥ 50% reduction in HAMD total score from baseline and had a final HAMD score of ≤ 17). Fifty-four (87%) patients were at least ‘minimally improved’ on the CGI scale. There were also significant improvements in mean total MADRS and BDI scores. Sertraline was well tolerated. Adverse events were reported by 84% of patients, but only 5% withdrew due to adverse events.
Conclusions: This study shows that patients with major depression who have failed to respond to moclobemide can generally be treated successfully with sertraline.