Factors associated with concomitant psychotropic drug use in the treatment of major depression: a STAR*D Report.

Journal Article (Journal Article)

INTRODUCTION: Concomitant psychotropic medication (CPM) treatment is common in persons with major depression (MDD). However, relationships with patient characteristics and response to treatment are unclear. METHODS: Participants with nonpsychotic MDD (N=2682) were treated with citalopram, 20-60 mg/day. Sociodemographic, clinical, and treatment outcome characteristics were compared between those using CPMs at study entry or during up to 14 weeks of citalopram treatment, and non-users. RESULTS: About 35% of participants used a CPM. Insomnia was the predominant indication (70.3%). CPM users were more likely to be seen in primary care settings (69.3% versus 30.7%), be white, of non-Hispanic ethnicity, married, and have a higher income, private insurance, and certain comorbid disorders. CPM users had greater depressive severity, poorer physical and mental functioning, and poorer quality of life than non-users. Response and remission rates were also lower. CPM users were more likely to achieve >50 mg/day of citalopram, to report greater side effect intensity, and to have serious adverse events, but less likely to be intolerant of citalopram. CONCLUSION: CPMs are associated with greater illness burden, more Axis I comorbidities (especially anxiety disorders), and lower treatment effectiveness. This suggests that CPM use may identify a more difficult to treat population that needs more aggressive treatment.

Full Text

Duke Authors

Cited Authors

  • Shelton, RC; Hollon, SD; Wisniewski, SR; Alpert, JE; Balasubramani, GK; Friedman, ES; Rush, AJ; Trivedi, MH; Preskorn, SH

Published Date

  • September 2009

Published In

Volume / Issue

  • 14 / 9

Start / End Page

  • 487 - 498

PubMed ID

  • 19890231

International Standard Serial Number (ISSN)

  • 1092-8529

Digital Object Identifier (DOI)

  • 10.1017/s1092852900023555


  • eng

Conference Location

  • United States