Journal
JOURNAL OF AFFECTIVE DISORDERS
Volume 133, Issue 3, Pages 467-476Publisher
ELSEVIER SCIENCE BV
DOI: 10.1016/j.jad.2011.04.032
Keywords
Escitalopram; Venlafaxine; Bupropion; Mirtazapine; Major depressive disorder; Melancholic features
Categories
Funding
- National Institute of Mental Health [N01MH90003]
- Lundbeck
- GlaxoSmithKline
- Advanced Neuromodulation Systems
- Best Practice Project Management
- Bristol-Myers Squibb/Otsuka
- Cyberonics
- Forest Pharmaceuticals
- Gerson Lehrman Group, GlaxoSmithKline
- Jazz Pharmaceuticals
- Magellan Health Services
- Merck Company
- Neuronetics
- Novartis Pharmaceuticals
- Ono Pharmaceuticals
- Organon
- Otsuka Pharmaceuticals
- Pamlab, Pfizer
- Transcept Pharmaceuticals
- Urban Institute
- Wyeth Ayerst
- Cyberonics Inc.
- Forest Laboratories
- Otsuka
- Guilford Publications
- Healthcare Technology Systems
- National Institutes of Mental Health
- Stanley Medical Research Institute
- Targacept, Inc.
- Pfizer, Inc.
- Bristol-Myers Squibb
- Eli Lilly and Company
- Janssen Pharmaceutica
- Pamlab
- Repligen, Inc.
- St. Jude Medical
- Aspect Medical System/Covidian
- Boehringer-Ingelheim
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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.
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