Eszopiclone Co-Administered With Fluoxetine in Patients With Insomnia Coexisting With Major Depressive Disorder

Maurizio Fava, W. Vaughn McCall, Andrew Krystal, Thomas Wessel, Robert Rubens, Judy Caron, David Amato, Thomas Roth

Research output: Contribution to journalArticle

361 Citations (Scopus)

Abstract

Background: Insomnia and major depressive disorder (MDD) can coexist. This study evaluated the effect of adding eszopiclone to fluoxetine. Methods: Patients who met DSM-IV criteria for both MDD and insomnia (n = 545) received morning fluoxetine and were randomized to nightly eszopiclone 3 mg (ESZ+FLX) or placebo (PBO+FLX) for 8 weeks. Subjective sleep and daytime function were assessed weekly. Depression was assessed with the 17-item Hamilton Rating Scale for Depression (HAM-D-17) and the Clinical Global Impression Improvement (CGI-I) and Severity items (CGI-S). Results: Patients in the ESZ+FLX group had significantly decreased sleep latency, wake time after sleep onset (WASO), increased total sleep time (TST), sleep quality, and depth of sleep at all double-blind time points (all p < .05). Eszopiclone co-therapy also resulted in: significantly greater changes in HAM-D-17 scores at Week 4 (p = .01) with progressive improvement at Week 8 (p = .002); significantly improved CGI-I and CGI-S scores at all time points beyond Week 1 (p < .05); and significantly more responders (59% vs. 48%; p = .009) and remitters (42% vs. 33%; p = .03) at Week 8. Treatment was well tolerated, with similar adverse event and dropout rates. Conclusions: In this study, eszopiclone/fluoxetine co-therapy was relatively well tolerated and associated with rapid, substantial, and sustained sleep improvement, a faster onset of antidepressant response on the basis of CGI, and a greater magnitude of the antidepressant effect.

Original languageEnglish (US)
Pages (from-to)1052-1060
Number of pages9
JournalBiological Psychiatry
Volume59
Issue number11
DOIs
StatePublished - Jun 1 2006

Fingerprint

Fluoxetine
Major Depressive Disorder
Sleep Initiation and Maintenance Disorders
Sleep
Antidepressive Agents
Depression
Eszopiclone
Diagnostic and Statistical Manual of Mental Disorders
Therapeutics
Placebos

Keywords

  • Insomnia
  • adjunctive antidepressant therapy
  • antidepressant remission rates
  • comorbidity
  • eszopiclone
  • major depressive disorder

ASJC Scopus subject areas

  • Biological Psychiatry

Cite this

Eszopiclone Co-Administered With Fluoxetine in Patients With Insomnia Coexisting With Major Depressive Disorder. / Fava, Maurizio; McCall, W. Vaughn; Krystal, Andrew; Wessel, Thomas; Rubens, Robert; Caron, Judy; Amato, David; Roth, Thomas.

In: Biological Psychiatry, Vol. 59, No. 11, 01.06.2006, p. 1052-1060.

Research output: Contribution to journalArticle

Fava, Maurizio ; McCall, W. Vaughn ; Krystal, Andrew ; Wessel, Thomas ; Rubens, Robert ; Caron, Judy ; Amato, David ; Roth, Thomas. / Eszopiclone Co-Administered With Fluoxetine in Patients With Insomnia Coexisting With Major Depressive Disorder. In: Biological Psychiatry. 2006 ; Vol. 59, No. 11. pp. 1052-1060.
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AB - Background: Insomnia and major depressive disorder (MDD) can coexist. This study evaluated the effect of adding eszopiclone to fluoxetine. Methods: Patients who met DSM-IV criteria for both MDD and insomnia (n = 545) received morning fluoxetine and were randomized to nightly eszopiclone 3 mg (ESZ+FLX) or placebo (PBO+FLX) for 8 weeks. Subjective sleep and daytime function were assessed weekly. Depression was assessed with the 17-item Hamilton Rating Scale for Depression (HAM-D-17) and the Clinical Global Impression Improvement (CGI-I) and Severity items (CGI-S). Results: Patients in the ESZ+FLX group had significantly decreased sleep latency, wake time after sleep onset (WASO), increased total sleep time (TST), sleep quality, and depth of sleep at all double-blind time points (all p < .05). Eszopiclone co-therapy also resulted in: significantly greater changes in HAM-D-17 scores at Week 4 (p = .01) with progressive improvement at Week 8 (p = .002); significantly improved CGI-I and CGI-S scores at all time points beyond Week 1 (p < .05); and significantly more responders (59% vs. 48%; p = .009) and remitters (42% vs. 33%; p = .03) at Week 8. Treatment was well tolerated, with similar adverse event and dropout rates. Conclusions: In this study, eszopiclone/fluoxetine co-therapy was relatively well tolerated and associated with rapid, substantial, and sustained sleep improvement, a faster onset of antidepressant response on the basis of CGI, and a greater magnitude of the antidepressant effect.

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