Factors Associated with Concomitant Psychotropic Drug Use in the Treatment of Major Depression: A STAR D Report

• Published in: CNS spectrums Vol. 14; no. 9; pp. 487 - 498
• Main Authors: Shelton, Richard C., Hollon, Steve D., Wisniewski, Stephen R., Alpert, Jonathan E., Balasubramani, G.K., Friedman, Edward S., Rush, A. John, Trivedi, Madhukar H., Preskorn, Sheldon H.
• Format: Journal Article
• Language: English
• Published: 01-09-2009
• ISSN: 1092-8529; 2165-6509
• DOI: 10.1017/S1092852900023555

Introduction:
Concomitant psychotropic medication (CPM) treatment is common in persons with major depression (MDD). However, relationships with patient characteristics and response to treatment are unclear.
Methods:
Participants with nonpsychotic MDD (N=2682) were treated with citalopram, 20–60 mg/day. Sociodemographic, clinical, and treatment outcome characteristics were compared between those using CPMs at study entry or during up to 14 weeks of citalopram treatment, and non-users.
Results:
About 35% of participants used a CPM. Insomnia was the predominant indication (70.3%). CPM users were more likely to be seen in primary care settings (69.3% versus 30.7%), be white, of non-Hispanic ethnicity, married, and have a higher income, private insurance, and certain comorbid disorders. CPM users had greater depressive severity, poorer physical and mental functioning, and poorer quality of life than non-users. Response and remission rates were also lower. CPM users were more likely to achieve ≥50 mg/day of citalopram, to report greater side effect intensity, and to have serious adverse events, but less likely to be intolerant of citalopram.
Conclusion:
CPMs are associated with greater illness burden, more Axis I comorbidities (especially anxiety disorders), and lower treatment effectiveness. This suggests that CPM use may identify a more difficult to treat population that needs more aggressive treatment.