Randomized comparison of selective serotonin reuptake inhibitor (escitalopram) monotherapy and antidepressant combination pharmacotherapy for major depressive disorder with melancholic features: a CO-MED report.

Abstract

BACKGROUND:

The clinical effects of antidepressant combinations vs. monotherapy as initial treatment for major depression with melancholic features (MDD-MF) are unknown.

METHODS:

Outpatients with chronic or recurrent major depression (MDD) were randomized to initial treatment with escitalopram+placebo (the MONO condition), bupropion-sustained release+escitalopram, or venlafaxine-extended release+mirtazapine (the COMB conditions) in the Combining Medications to Enhance Depression Outcomes (CO-MED) trial. Secondary data analyses were conducted to compare demographic and clinical characteristics, and contrast clinical responses according to drug treatment, in patients with MDD-MF (n=124) and non-melancholic MDD (n=481).

RESULTS:

While numerically lower, remission rates in MDD-MF did not differ significantly from those with non-melancholic MDD either at 12 (33.1% vs. 41.0%, aOR 1.16, p=0.58) or 28 (39.5% vs. 46.8%, aOR=1.02, p=0.93) weeks of treatment. Remission rates did not differ significantly between combination and monotherapy groups in either MDD-MF or non-melancholic MDD patients at either time point. Similar conclusions were reached for response rates, premature study discontinuation, and self-rated depression symptom severity.

LIMITATIONS:

This is a secondary analysis of data from the CO-MED trial, which was not designed to address differential treatment response in melancholic and non-melancholic MDD.

CONCLUSIONS:

We found no evidence of differential remission or response rates to antidepressant combination or monotherapy between melancholic/non-melancholic MDD patients, or according to antidepressant treatment group, after 12 and 28 weeks. Melancholic features may not be a valid predictor of more favorable response to antidepressant combination therapy as initial treatment.

• Authors: William V Bobo, Helen Chen, Madhukar H Trivedi, Jonathan W Stewart, Andrew A Nierenberg, Maurizio Fava, Benji T Kurian, Diane Warden, David W Morris, James F Luther, Mustafa M Husain, Ian A Cook, Ira M Lesser, Susan G Kornstein, Stephen R Wisniewski, A John Rush, Richard C Shelton
• Journal: Journal of affective disorders (J Affect Disord) Vol. 133 Issue 3 Pg. 467-76 (Oct 2011) ISSN: 1573-2517 [Electronic] Netherlands
• PMID: 21601287 (Publication Type: Comparative Study, Journal Article, Randomized Controlled Trial)
• Copyright: Copyright © 2011 Elsevier B.V. All rights reserved.

Chemical References

• Antidepressive Agents
• Antidepressive Agents, Second-Generation
• Cyclohexanols
• Serotonin Uptake Inhibitors
• Bupropion
• Citalopram
• Venlafaxine Hydrochloride

Topics

• Adult
• Aged
• Antidepressive Agents (adverse effects, therapeutic use)
• Antidepressive Agents, Second-Generation (therapeutic use)
• Bupropion (therapeutic use)
• Citalopram (adverse effects, therapeutic use)
• Cyclohexanols (therapeutic use)
• Depression
• Depressive Disorder (chemically induced, diagnosis, drug therapy)
• Depressive Disorder, Major (chemically induced, diagnosis, drug therapy)
• Drug Therapy, Combination
• Female
• Humans
• Male
• Middle Aged
• Outpatients
• Selective Serotonin Reuptake Inhibitors (adverse effects, therapeutic use)
• Single-Blind Method
• Treatment Outcome
• Venlafaxine Hydrochloride