Combining medications to enhance depression outcomes (CO-MED): acute and long-term outcomes of a single-blind randomized study.

Journal Article (Journal Article;Multicenter Study)

OBJECTIVE: Two antidepressant medication combinations were compared with selective serotonin reuptake inhibitor monotherapy to determine whether either combination produced a higher remission rate in first-step acute-phase (12 weeks) and long-term (7 months) treatment. METHOD: The single-blind, prospective, randomized trial enrolled 665 outpatients at six primary and nine psychiatric care sites. Participants had at least moderately severe nonpsychotic chronic and/or recurrent major depressive disorder. Escitalopram (up to 20 mg/day) plus placebo, sustained-release bupropion (up to 400 mg/day) plus escitalopram (up to 20 mg/day), or extended-release venlafaxine (up to 300 mg/day) plus mirtazapine (up to 45 mg/day) was delivered (1:1:1 ratio) by using measurement-based care. The primary outcome was remission, defined as ratings of less than 8 and less than 6 on the last two consecutive applications of the 16-item Quick Inventory of Depressive Symptomatology--Self-Report. Secondary outcomes included side effect burden, adverse events, quality of life, functioning, and attrition. RESULTS: Remission and response rates and most secondary outcomes were not different among treatment groups at 12 weeks. The remission rates were 38.8% for escitalopram-placebo, 38.9% for bupropion-escitalopram, and 37.7% for venlafaxine-mirtazapine, and the response rates were 51.6%-52.4%. The mean number of worsening adverse events was higher for venlafaxine-mirtazapine (5.7) than for escitalopram-placebo (4.7). At 7 months, remission rates (41.8%-46.6%), response rates (57.4%-59.4%), and most secondary outcomes were not significantly different. CONCLUSIONS: Neither medication combination outperformed monotherapy. The combination of extended-release venlafaxine plus mirtazapine may have a greater risk of adverse events.

Full Text

Duke Authors

Cited Authors

  • Rush, AJ; Trivedi, MH; Stewart, JW; Nierenberg, AA; Fava, M; Kurian, BT; Warden, D; Morris, DW; Luther, JF; Husain, MM; Cook, IA; Shelton, RC; Lesser, IM; Kornstein, SG; Wisniewski, SR

Published Date

  • July 2011

Published In

Volume / Issue

  • 168 / 7

Start / End Page

  • 689 - 701

PubMed ID

  • 21536692

Electronic International Standard Serial Number (EISSN)

  • 1535-7228

Digital Object Identifier (DOI)

  • 10.1176/appi.ajp.2011.10111645

Language

  • eng

Conference Location

  • United States