Reboxetine in the treatment of depression: Early clinical experience in the UK

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Abstract
The potential efficacy and tolerability of new antidepressants can best be assessed through randomized controlled trials (RCTs). However, the patient population in antidepressant studies is a highly selected group, so the results from such studies may not be applicable to routine clinical practice. This paper describes a questionnaire survey of senior psychiatrists in the UK aimed at evaluating early clinical experience with reboxetine, a new, selective noradrenaline re-uptake inhibitor (selective NRI) recently introduced in the UK for the treatment of depression. Psychiatrists were asked for details of their experience with reboxetine in depression, illustrated with representative case histories. The spontaneous adverse events reported to the Medicines Control Agency (MCA) were also reviewed. Information was collected on over 250 patients, 50% of whom had responded sub-optimally to previous physical treatments for this current episode; over 50% had co-morbid psychiatric disorders, and 29.1% had coexisting physical illness. Most of the patients were treated with 8 mg/day of reboxetine. The overall clinical response to reboxetine, as judged by the treating doctor, was considered ‘good’ in over 65% of patients. Three-quarters of them showed ‘good/very good’ improvement in their symptoms; the same proportion achieved a ‘good/very good’ improvement in activities of daily living. Two-thirds of patients did not report any troublesome side-effects, the profile being consistent with that seen in RCTs. Analysis of spontaneous adverse events reported to the MCA has not as yet revealed any surprises. Early clinical experience with reboxetine in routine practice is encouraging. Efficacy, tolerability and simple dosing appear to be particular benefits to patients. Consistent with data from RCTs involving reboxetine, recovery of function accompanies symptomatic improvement, which may be related to the selective effects of the drug on noradrenaline.