Combining medications to enhance depression outcomes (co-med): Acute and long-term outcomes of a single-blind randomized study
American Journal of Psychiatry, 05/20/2011
Clinical Article
Rush AJ et al. – Neither medication combination outperformed monotherapy. The combination of extended-release venlafaxine plus mirtazapine may have a greater risk of adverse events.
Methods- Single-blind, prospective, randomized trial enrolled 665 outpatients at 6 primary and 9 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) delivered (1:1:1 ratio) by using measurement-based care
- Primary outcome was remission, defined as ratings of less than 8 and less than 6 on last 2 consecutive applications of 16-item Quick Inventory of Depressive Symptomatology-Self-Report
- Secondary outcomes included SE burden, AE, QOL, functioning, and attrition
- Remission and response rates and most secondary outcomes were not different among treatment groups at 12 weeks
- Remission rates 38.8% for escitalopram-placebo, 38.9% for bupropion-escitalopram, and 37.7% for venlafaxine-mirtazapine, and response rates 51.6%–52.4%
- Mean number of worsening AE 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 not significantly different
