PMID- 23764690
OWN - NLM
STAT- MEDLINE
DCOM- 20140218
LR  - 20130701
IS  - 1533-712X (Electronic)
IS  - 0271-0749 (Linking)
VI  - 33
IP  - 4
DP  - 2013 Aug
TI  - Potential benefits of slow titration of paroxetine treatment in an elderly 
      population: eight-week results from a naturalistic setting.
PG  - 565-9
LID - 10.1097/JCP.0b013e3182905967 [doi]
AB  - BACKGROUND: Late-life depression, often in association with anxiety, affects 
      approximately 15% of individuals older than 65 years. Selective serotonin 
      reuptake inhibitors are the first-line treatment but could be responsible of an 
      early exacerbation of anxiety, possibly reduced by a very gradual titration of 
      drugs. The main aim of this study is to compare gradual and rapid (standard) 
      titration of paroxetine in an elderly population. METHODS: In a naturalistic 
      setting, 50 elderly (>/=60 years old) outpatients with unipolar mood disorder or 
      anxiety disorder were naturalistically assigned to abrupt initiation of 10 mg of 
      paroxetine or to a gradual increase with 2.5 mg on alternate days up to 10 mg in 
      7 days. Then dosage could be maintained at 10 mg or increased according to 
      clinical response. Primary outcome was efficacy as assessed by the Hamilton 
      Depression Rating Scale (HAM-D) 21, HAM-D symptom subscales (core, psychic 
      anxiety, somatic anxiety cluster), and Hamilton Anxiety Rating Scale changes. 
      Secondary outcome was evaluation of overall dropouts at eighth week and 
      evaluation of most common adverse effects through the global judgment of the 
      Dosage Record and Treatment Emergent Symptom Scale. All data were recorded weekly 
      for the first 8 weeks of treatment (with 1 more evaluation after 3 days from the 
      baseline). RESULTS: Samples were comparable at baseline, with patients in gradual 
      titration showing a higher level of psychic anxiety. During the first 3 days of 
      treatment, a significant worsening in psychic anxiety was observed in patients 
      treated abruptly with 10 mg of paroxetine (difference in HAM-D psychic anxiety 
      subscale from baseline: 110.61% vs 89.38% with rapid and slow titration, 
      respectively; t test P = 0.03). Overall, a significantly greater improvement in 
      depressive and anxious symptoms favored gradual titration (HAM-D core cluster and 
      HAM-D psychic anxiety cluster, respectively, P = 0.014 and P < 0.001, also when 
      controlling for confounders). At the eighth week, significant higher dropouts in 
      patients administered with abrupt dosage was observed (12.00% vs 40.91%, P = 
      0.02, respectively for slow and rapid titration). CONCLUSIONS: Our results 
      suggest that a gradual titration of paroxetine could avoid the initial treatment 
      anxiety worsening and dropout at the beginning of the treatment.
FAU - Gibiino, Sara
AU  - Gibiino S
AD  - Institute of Psychiatry, University of Bologna, Italy.
FAU - Mori, Elisa
AU  - Mori E
FAU - De Ronchi, Diana
AU  - De Ronchi D
FAU - Serretti, Alessandro
AU  - Serretti A
LA  - eng
PT  - Comparative Study
PT  - Journal Article
PT  - Pragmatic Clinical Trial
PL  - United States
TA  - J Clin Psychopharmacol
JT  - Journal of clinical psychopharmacology
JID - 8109496
RN  - 0 (Antidepressive Agents, Second-Generation)
RN  - 41VRH5220H (Paroxetine)
SB  - IM
MH  - Age Factors
MH  - Aged
MH  - Aged, 80 and over
MH  - Analysis of Variance
MH  - Antidepressive Agents, Second-Generation/*administration & dosage/adverse effects
MH  - Anxiety Disorders/diagnosis/*drug therapy/psychology
MH  - Chi-Square Distribution
MH  - Depressive Disorder/diagnosis/*drug therapy/psychology
MH  - Drug Administration Schedule
MH  - Female
MH  - Humans
MH  - Italy
MH  - Male
MH  - Paroxetine/*administration & dosage/adverse effects
MH  - Patient Dropouts
MH  - Psychiatric Status Rating Scales
MH  - Time Factors
MH  - Treatment Outcome
EDAT- 2013/06/15 06:00
MHDA- 2014/02/19 06:00
CRDT- 2013/06/15 06:00
PHST- 2013/06/15 06:00 [entrez]
PHST- 2013/06/15 06:00 [pubmed]
PHST- 2014/02/19 06:00 [medline]
AID - 10.1097/JCP.0b013e3182905967 [doi]
PST - ppublish
SO  - J Clin Psychopharmacol. 2013 Aug;33(4):565-9. doi: 10.1097/JCP.0b013e3182905967.