Posted by Phillipa on May 10, 2011, at 20:22:25
Probably biased as drug companies were involved for you interest only Phillipa
From Medscape Medical News
Dual Antidepressants May Not Be Better Than Monotherapy
Laurie Barclay, MDAuthors and Disclosures
May 10, 2011 Dual medications for depression increased costs and adverse effects with no benefit to patients and no greater efficacy than monotherapy, according to the results of a single-blind, prospective randomized study reported online May 2 in the American Journal of Psychiatry."Clinicians should not rush to prescribe combinations of antidepressant medications as first-line treatment for patients with major depressive disorder," principal investigator Madhukar H. Trivedi, MD, professor of psychiatry and chief of the Division of Mood Disorders at the University of Texas Southwestern, Dallas, said in a news release. "The clinical implications are very clear the extra cost and burden of two medications is not worthwhile as a first treatment step."
The goal of the Combining Medication to Enhance Depression Outcomes study was to compare antidepressant medication combinations with selective serotonin reuptake inhibitor monotherapy to see whether either combination was associated with increased rate of remission in first-step, acute-phase treatment (12 weeks) and long-term treatment (7 months).
At 6 primary and 9 psychiatric care sites, 665 outpatients with at least moderately severe nonpsychotic chronic and/or recurrent major depressive disorder were enrolled. Using measurement-based care, participants received 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).
Remission, defined as ratings of less than 8 and less than 6 on the last 2 consecutive applications of the 16-item Quick Inventory of Depressive SymptomatologySelf-Report, was the main study endpoint. Adverse effect burden, adverse events, quality of life, functioning, and study attrition were secondary endpoints.
At 12 weeks, the treatment groups did not differ in remission rates, response rates (51.6% - 52.4%), or most secondary endpoints. Remission rates were 38.8% for escitalopram-placebo, 38.9% for bupropion-escitalopram, and 37.7% for venlafaxine-mirtazapine.
Similarly, there was no significant difference among groups at 7 months in remission rates (41.8% - 46.6%), response rates (57.4% - 59.4%), and most secondary endpoints. Compared with escitalopram-placebo, venlafaxine-mirtazapine was associated with a higher mean number of serious adverse events (5.7 vs 4.7).
"Neither medication combination outperformed monotherapy," the study authors write. "The combination of extended-release venlafaxine plus mirtazapine may have a greater risk of adverse events."
Limitations of this study include a lack of generalizability to all outpatients with chronic and/or recurrent major depression, possibly insufficient doses used, lack of blinding, and lack of a structured interview to establish axis I diagnoses. In addition, participants were not randomized again or stratified by level of improvement after the acute phase.
"In summary, in outpatients with chronic and/or recurrent major depressive disorder, there appears to be no advantage to either medication combination over escitalopram alone as a first-step treatment for non-resistant depression," the study authors conclude.
The National Institute of Mental Health supported this study. Forest Pharmaceuticals, GlaxoSmithKline, Organon and Wyeth Pharmaceuticals provided the study medications. The study authors report various financial relationships with pharmaceutical studies, as listed in the journal article.
Am J Psychiatry. Published online May 2, 2011
poster:Phillipa
thread:985044
URL: http://www.dr-bob.org/babble/20110502/msgs/985044.html