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

Journal Article (Journal Article)

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.

Full Text

Duke Authors

Cited Authors

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

Published Date

  • October 2011

Published In

Volume / Issue

  • 133 / 3

Start / End Page

  • 467 - 476

PubMed ID

  • 21601287

Pubmed Central ID

  • PMC10177662

Electronic International Standard Serial Number (EISSN)

  • 1573-2517

Digital Object Identifier (DOI)

  • 10.1016/j.jad.2011.04.032


  • eng

Conference Location

  • Netherlands