Combination antidepressant therapy for major depressive disorder: Speed and probability of remission

• Published in: Journal of psychiatric research Vol. 52; pp. 7 - 14
• Main Authors: Stewart, Jonathan W, McGrath, Patrick J, Blondeau, Claude, Deliyannides, Deborah A, Hellerstein, David, Norris, Sandhaya, Amat, Jose, Pilowsky, Daniel J, Tessier, Pierre, Laberge, Louise, O'Shea, Donna, Chen, Ying, Withers, Amy, Bergeron, Richard, Blier, Pierre
• Format: Journal Article
• Language: English
• Published: Kidlington Elsevier Ltd 01-05-2014; Elsevier
• Subjects: Adolescent; Adult; Adult and adolescent clinical studies; Aged; Analysis of Variance; Antidepressant drugs; Antidepressive Agents - adverse effects; Biological and medical sciences; Bupropion; Bupropion - adverse effects; Canada; Citalopram - adverse effects; Combination treatment; Depression; Depressive Disorder, Major - drug therapy; Depressive Disorder, Major - epidemiology; Depressive personality disorders; Dose-Response Relationship, Drug; Double-Blind Method; Drug Therapy, Combination; Escitalopram; Female; Follow-Up Studies; Humans; Major depression; Male; Medical sciences; Middle Aged; Miscellaneous; Mood disorders; Neuropharmacology; Pharmacology. Drug treatments; Psychiatric Status Rating Scales; Psychiatry; Psychoanaleptics: cns stimulant, antidepressant agent, nootropic agent, mood stabilizer; Psychoanaleptics: cns stimulant, antidepressant agent, nootropic agent, mood stabilizer..., (alzheimer disease); Psychology. Psychoanalysis. Psychiatry; Psychopathology. Psychiatry; Psychopharmacology; Randomization; Recurrence; Remission; Treatment Outcome; United States; Young Adult; Canada; United States; Remission; Combination treatment; Bupropion; Major depression; Escitalopram; Mood disorder; Serotonin; Psychotropic; Depression; Reuptake inhibitor; Velocity; Selective serotonin reuptake inhibitor; Neurotransmitter; Antidepressant agent; Combined treatment
• ISSN: 0022-3956; 1879-1379
• DOI: 10.1016/j.jpsychires.2013.12.001

Abstract Introduction Only about a third of patients with an episode of major depressive disorder remit with a given treatment and few remissions occur within the first weeks of treatment. This study tested whether combining escitalopram and bupropion as initial treatment would result in quicker remission and a higher remission rate than monotherapy with either drug. Method Two hundred forty-five outpatients aged 18–65 having non-psychotic, non-bipolar major depression were randomly assigned to double-blind treatment with bupropion or escitalopram or the combination dosed to a maximum of bupropion 450 mg/d and/or escitalopram 40 mg/d for 12 weeks. A Montgomery–Asberg Depression Rating Scale score of 22 was required for randomization, while a Hamilton Rating Scale for Depression score ≤ 7 defined remission. We hypothesized that bupropion plus escitalopram would outperform both monotherapies in both earlier onset of remission and higher rate of remission. Results Primary analyses did not demonstrate that dual therapy outperformed both monotherapies in either timing of remission or remission rate. All three treatments were well tolerated. Discussion These results do not support initial use of bupropion plus escitalopram to speed or enhance antidepressant response. Clinical trials registration NCT00519428.