Does dual antidepressant therapy as initial treatment hasten and increase remission from depression?
BACKGROUND
Only 30%-40% of depressed patients remit after 8 weeks of treatment with an antidepressant. We hypothesized that beginning treatment with two antidepressants would improve remission rates.


METHODS
Relatively treatment-naive depressed outpatients (with DSM-IV diagnoses of major depressive disorder, dysthymic disorder, or depression not otherwise specified) were initially treated with a combination of escitalopram (ESC) plus bupropion (BUP), using rapid dose escalation to ESC 40 mg/day plus BUP 400 to 450 mg/day by study day 15 in an open-label, 8-week study. Remission was defined as a score < or =7 on the 17-item Hamilton Rating Scale for Depression (HAM-D17) at the end of the study. Recruitment occurred between July, 2003, and June, 2006, and the final patient completed the protocol in July, 2006.


RESULTS
Fifty-five patients signed informed consent, 49 of whom received at least one dose of study medication. Of the 49 patients, 28 (57%) were women and 30 (61%) had a current diagnosis of major depressive disorder; the mean age was 38+/-12 years, and the mean pre-treatment HAM-D17 score was 16+/-4. Sixteen (33%) of the patients remitted by study week 2, and 31 (63%) by week 8. Nine patients (18%) dropped out prior to their week 8 visit, 5 of them because of side effects.


CONCLUSIONS
The lack of a comparison group and the use of non-blind raters are drawbacks of this study.


CONCLUSIONS
This open-label study suggests that increased numbers of patients may benefit from dual therapy with ESC plus BUP and that the benefit may perhaps include an increased likelihood of early response. Registry: ClinicalTrials.gov: http://www.clinicaltrials.gov/NCT00296712 (Journal of Psychiatric Practice. 2009;15:337-345).
Stewart
Jonathan W
JW
New York State Psychiatric Institute and Columbia University College of Physicians and Surgeons, New York, USA. jws6@columbia.edu
McGrath
Patrick J
PJ
Deliyannides
Rodeborah A
RA
Quitkin
Frederic M
FM
D000328:Adult; D018687:Antidepressive Agents, Second-Generation / Q000008:administration & dosage* / Q000009:adverse effects / Q000627:therapeutic use; D016642:Bupropion / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use; D015283:Citalopram / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use; D003866:Depressive Disorder / Q000188:drug therapy*; D003865:Major Depressive Disorder / Q000188:drug therapy; D004359:Drug Therapy, Combination; D019263:Dysthymic Disorder / Q000188:drug therapy; D005260:Female; D006801:Humans; D008297:Male; D015588:Observer Variation; D010865:Pilot Projects; D012074:Remission Induction
D018687:Antidepressive Agents, Second-Generation; D016642:Bupropion; D015283:Citalopram