title: Factors associated with concomitant psychotropic drug use in the treatment of major depression: a STAR*D Report.
abstract: BACKGROUND
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Psychiatry, Vanderbilt University, Nashville, TN 37212, USA.
authors.forename: Rchard C
authors.initials: RC
authors.lastname: Shelton
authors.forename: Steve D
authors.initials: SD
authors.lastname: Hollon
authors.forename: Stephen R
authors.initials: SR
authors.lastname: Wisniewski
authors.forename: Jonathan E
authors.initials: JE
authors.lastname: Alpert
authors.forename: G K
authors.initials: GK
authors.lastname: Balasubramani
authors.forename: Edward S
authors.initials: ES
authors.lastname: Friedman
authors.forename: A John
authors.initials: AJ
authors.lastname: Rush
authors.forename: Madhukar H
authors.initials: MH
authors.lastname: Trivedi
authors.forename: Sheldon H
authors.initials: SH
authors.lastname: Preskorn
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D014151:Anti-Anxiety Agents / Q000627:therapeutic use; D018687:Antidepressive Agents, Second-Generation / Q000627:therapeutic use; D015283:Citalopram / Q000627:therapeutic use; D003865:Major Depressive Disorder / Q000150:complications / Q000188:drug therapy*; D017831:Diagnosis, Dual (Psychiatry); D004359:Drug Therapy, Combination; D005260:Female; D006633:Histamine Antagonists / Q000627:therapeutic use; D006801:Humans; D008297:Male; D008875:Middle Aged; D011569:Psychiatric Status Rating Scales; D011619:Psychotropic Drugs / Q000009:adverse effects / Q000627:therapeutic use*; D012959:Socioeconomic Factors; D019966:Substance-Related Disorders / Q000150:complications / Q000628:therapy; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D014151:Anti-Anxiety Agents; D018687:Antidepressive Agents, Second-Generation; D006633:Histamine Antagonists; D011619:Psychotropic Drugs; D015283:Citalopram