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Depression Drug Combos Not Superior to Monotherapy

Last Updated: May 24, 2011.

Response and remission rates do not seem to differ between two antidepressant drug combinations and monotherapy with a selective serotonin reuptake inhibitor; however, there may be more serious adverse events with a drug combination, according to a study published online May 2 in The American Journal of Psychiatry.

TUESDAY, May 24 (HealthDay News) -- Response and remission rates do not seem to differ between two antidepressant drug combinations and monotherapy with a selective serotonin reuptake inhibitor; however, there may be more serious adverse events with a drug combination, according to a study published online May 2 in The American Journal of Psychiatry.

A. John Rush, M.D., of the Duke-National University of Singapore Graduate Medical School, and colleagues randomized 665 outpatients (at six primary and nine psychiatric care sites) with at least moderately severe nonpsychotic chronic and/or recurrent major depressive disorder to 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).

At 12 weeks, the investigators found that remission and response rates and most secondary outcomes -- including side effect burden, adverse events, quality of life, functioning, and attrition -- were not different among the three treatment groups. The remission rates were 38.8 percent for escitalopram-placebo, 38.9 percent for bupropion-escitalopram, and 37.7 percent for venlafaxine-mirtazapine. The response rates ranged between 51.6 and 52.4 percent. Compared to escitalopram-placebo, the mean number of serious adverse events was higher for venlafaxine-mirtazapine (5.7 versus 4.7). At seven months, the remission and response rates as well as secondary outcomes were not significantly different.

"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 nonresistant depression," the authors write.

Forest Pharmaceuticals, GlaxoSmithKline, Organon, and Wyeth Pharmaceuticals provided medications for this trial at no cost. Several authors disclosed financial relationships with these companies and other pharmaceutical companies.

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