Background: The prevalence of major depressive disorder (MDD) in human immunodeficiency virus (HIV)-seropositive patients is higher than in the general population. The treatment of comorbidities of HIV infection, such as depression, is an important target in the clinical management of these patients. The use of antidepressants in HIV patients can be complicated by the pharmacokinetic interaction between antidepressants and antiretroviral agents. Several antidepressants and antiretrovirals are metabolized by cytochrome P450 (CYP450). Reboxetine is a noradrenergic antidepressant that is not metabolized by CYP450 and may offer a valuable option in the treatment of MDD in HIV-seropositive patients.
Method: Twenty HIV-infected outpatients with MDD according to DSM-IV criteria were treated with reboxetine, 8 mg/day, for 12 weeks within an open trial design. Outcome measures included the Montgomery-Asberg Depression Rating Scale (MADRS) and a side effect profile. Data were gathered from July 2000 to March 2001.
Results: Seventy-five percent of patients (N = 15) completed the trial. All patients who completed the trial had an improvement equal to or higher than a 50% reduction in their MADRS scores at endpoint. The most frequent adverse effects were insomnia, sweating, and shivering.
Conclusion: Within this open trial, reboxetine was found to be effective in reducing depressive symptoms in HIV illness. The rate of dropout (25%) suggests that reboxetine may be well tolerated in this population.