Background: Anxiety symptoms in depression result often in treatment resistance, residual symptoms, and persistent functional impairment.
Objective: To assess the effectiveness and safety of adjunctive pregabalin to antidepressants for residual anxiety in patients with major depressive disorder (MDD).
Methods: A retrospective chart review was conducted to identify partial responders among patients with MDD with residual anxiety. Twenty such patients (age, 58.4 ± 11.2 years; 15 women; baseline Hamilton Depression Rating Scale [HDRS], 17.1 ± 3.5) who received adjunctive pregabalin for residual anxiety were included. Antidepressants augmented were the selective serotonin reuptake inhibitors (n = 12), mirtazapine (n = 2), and selective serotonin-norepinephrine reuptake inhibitors (n = 6).
Results: Twenty patients received at least 4 weeks of pregabalin treatment after 8 weeks of antidepressant therapy. At week 1 (9 weeks after initiating treatment), pregabalin was prescribed at a mean ± SD dose of 71.2 ± 31.7 mg, and the mean maximum pregabalin dose prescribed was 156.2 ± 76.5 mg (range, 75–300 mg). At week 8, there were 13 responders (13/20 [65%]), and 7 of these 13 patients achieved remission (HDRS17 < 8). There were significant decreases in HDRS scores (13.5 ± 3.1 vs 9.1 ± 2.9, P < 0.000), and HDRS anxiety/somatization subscale scores (6.3 ± 2 to 3.6 ± 1.7, P < 0.000). Adverse effects included somnolence (n = 7), weight gain (n = 3), dizziness (n = 4), dry mouth (n = 6), edema (n = 3), blurred vision (n = 3), difficulty with concentration/attention (n = 8), headache (n = 6), and diarrhea (n = 5).
Conclusions: The results suggest a possible augmentation role for pregabalin when used in conjunction with conventional antidepressants for residual anxiety in MDD.
From the *Department of Clinical Medicine, Sapienza-University of Rome, Rome, Italy; †Department of Psychiatry, Harvard University, Cambridge; ‡Department of Psychiatry, Massachusetts General Hospital, Boston, MA; §Department of Psychiatry, Modena and Reggio Emilia University, Modena and Reggio Emilia; and ∥Department of Psychiatry Sapienza-University of Rome, Rome, Italy.
Received August 8, 2011; accepted after revision April 10, 2012.
Reprints: Mario Vitali, MD, 1 Bowdoin Sq, 6th floor, DCRP, Boston, MA 02114 (e-mail: firstname.lastname@example.org).