Combined therapy leads to more remission of depression

January 01, 0001

Combined therapy leads to more remission of depression

In this double-blind study, the authors form the US and Canada sought to produce evidence for the superiority of different combinations of antidepressant drugs from treatment initiation. Patients (N=105) meeting DSM- IV criteria for major depressive disorder were randomly assigned to receive, from treatment initiation, either fluoxetine monotherapy (20 mg/day) or mirtazapine (30 mg/day) in combination with fluoxetine (20 mg/day), venlafaxine (225 mg/day titrated in 14 days), or extended release bupropion (150 mg/day) for 6 weeks. The Hamilton Depression Rating Scale (HAM-D) was the principal measurement tool.

They found: "The overall dropout rate was 15%, without notable differences among the four groups. Compared with fluoxetine monotherapy, all three combination groups had significantly greater improvements on the HAM-D. Remission rates (defined as a HAM-D score of 7 or less) were 25% for fluoxetine, 52% for mirtazapine plus fluoxetine, 58% for mirtazapine plus venlafaxine, and 46% for mirtazapine plus bupropion. Among patients who had a marked response, double-blind discontinuation of one agent produced a relapse in about 40% of cases."

The authors concluded: "The combination treatments were as well tolerated as fluoxetine monotherapy and more clinically effective. The study results, which add to a growing body of evidence, suggest that use of antidepressant combinations from treatment initiation may double the likelihood of remission compared with use of a single medication."

A trade-off for higher remission rate was that the mirtazapine groups all had mean weight gains of 2-3 kg during the 6-week study while fluoxetine alone did not.

For the full abstract, click here.

Am J Psychiatry 167:281-288, March 2010
© 2010 to the American Psychiatric Association
Combination of Antidepressant Medications From Treatment Initiation for Major Depressive Disorder: A Double-Blind Randomized Study. Pierre Blier, Herbert E. Ward, Philippe Tremblay, Louise Laberge, Chantal Hébert, and Richard Bergeron.

Category: P. Psychological. Keywords: depression, monotherapy, combined therapy, fluoxetine, mirtazapine, venlafaxine, bupropion, Hamilton Depression Rating Scale, randomized controlled trial, journal watch.
Synopsis edited by Dr Linda French, Toledo, Ohio. Posted on Global Family Doctor 13 April 2010

Pearls are an independent product of the Cochrane primary care group and are meant for educational use and not to guide clinical care.