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Adjunctive Pregabalin in Partial Responders With Major Depressive Disorder and Residual Anxiety

Vitali, Mario MD*†‡; Tedeschini, Enrico MD§; Mistretta, Martino MD; Fehling, Kiki BA; Aceti, Franca MD; Ceccanti, Mauro MD*; Fava, Maurizio MD†‡

Journal of Clinical Psychopharmacology: February 2013 - Volume 33 - Issue 1 - p 95–98
doi: 10.1097/JCP.0b013e31827b9351
Brief Reports

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: vitalimario@yahoo.it).

© 2013 Lippincott Williams & Wilkins, Inc.