Please use this identifier to cite or link to this item: https://doi.org/10.1016/j.jad.2011.04.032
Title: Randomized comparison of selective serotonin reuptake inhibitor (escitalopram) monotherapy and antidepressant combination pharmacotherapy for major depressive disorder with melancholic features: A CO-MED report
Authors: Bobo, W.V.
Chen, H.
Trivedi, M.H.
Stewart, J.W.
Nierenberg, A.A.
Fava, M.
Kurian, B.T.
Warden, D.
Morris, D.W.
Luther, J.F.
Husain, M.M.
Cook, I.A.
Lesser, I.M.
Kornstein, S.G.
Wisniewski, S.R.
Rush, A.J. 
Shelton, R.C.
Keywords: Bupropion
Escitalopram
Major depressive disorder
Melancholic features
Mirtazapine
Venlafaxine
Issue Date: Oct-2011
Source: Bobo, W.V., Chen, H., Trivedi, M.H., Stewart, J.W., Nierenberg, A.A., Fava, M., Kurian, B.T., Warden, D., Morris, D.W., Luther, J.F., Husain, M.M., Cook, I.A., Lesser, I.M., Kornstein, S.G., Wisniewski, S.R., Rush, A.J., Shelton, R.C. (2011-10). 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 133 (3) : 467-476. ScholarBank@NUS Repository. https://doi.org/10.1016/j.jad.2011.04.032
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. © 2011 Elsevier B.V. All rights reserved.
Source Title: Journal of Affective Disorders
URI: http://scholarbank.nus.edu.sg/handle/10635/110621
ISSN: 01650327
DOI: 10.1016/j.jad.2011.04.032
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