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 OF AFFECTIVE DISORDERS

卷:133

Article

Bobo, William V.¹  Chen, Helen²  Trivedi, Madhukar H.³  Nierenberg, Andrew A.⁴  Fava, Maurizio⁴  Kurian, Benji T.³  Warden, Diane³  Morris, David W.^3,5,6  Luther, James F.⁷  Husain, Mustafa M.³  Cook, Ian A.⁸  Lesser, Ira M.^9,10  Kornstein, Susan G.^11,12  Wisniewski, Stephen R.⁷  Rush, A. John¹³  Shelton, Richard C.¹ 

[1] Vanderbilt Univ, Sch Med, Dept Psychiat, Nashville, TN 37212 USA

[2] KK Womens & Childrens Hosp, Mental Wellness Serv, Singapore, Singapore

[3] Univ Texas SW Med Ctr Dallas, Dept Psychiat, Dallas, TX 75390 USA

[4] Massachusetts Gen Hosp, Depress Clin & Res Program, Boston, MA 02114 USA

[5] New York State Psychiat Inst & Hosp, New York, NY 10032 USA

[6] Columbia Univ, Coll Phys & Surg, Dept Psychiat, New York, NY 10027 USA

[7] Univ Pittsburgh, Grad Sch Publ Hlth, Epidemiol Data Ctr, Pittsburgh, PA USA

[8] Univ Calif Los Angeles, Semel Inst Neurosci & Human Behav, Depress Res & Clin Program, Los Angeles, CA USA

[9] Harbor UCLA Med Ctr, Dept Psychiat, Torrance, CA 90509 USA

[10] Los Angeles Biomed Res Inst, Torrance, CA USA

[11] Virginia Commonwealth Univ, Dept Psychiat, Richmond, VA USA

[12] Virginia Commonwealth Univ, Inst Womens Hlth, Richmond, VA USA

[13] Duke NUS Grad Med Sch Singapore, Singapore, Singapore

关键词: Escitalopram;    Venlafaxine;    Bupropion;    Mirtazapine;    Major depressive disorder;    Melancholic features;   

DOI  :  10.1016/j.jad.2011.04.032

来源: Elsevier

【 摘 要 】

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. (C) 2011 Elsevier B.V. All rights reserved.

【 授权许可】

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