Is combined treatment more effective than switching to monotherapy in patients with resistant depression? A retrospective study.
OBJECTIVE
The aim of this retrospective study was to compare the efficacy of combination therapy (combinations of antidepressants and various augmentations) and antidepressant monotherapy in the treatment of patients, who failed to respond at least to one previous antidepressant trial in the routine clinical practice.


METHODS
We reviewed chart documents of patients hospitalized at Prague Psychiatric Center for depressive disorder from June 2005 to June 2007 and finished at least 4 weeks of new treatment. Depressive symptoms and overall clinical status were assessed using Montgomery and Asberg Depression Rating Scale, Clinical Global Impression and Beck Depression Inventory - Short Form at the baseline and in the end of treatment.


RESULTS
We identified 49 inpatients (24-combined treatment, 25-monotherapy), who were suitable for analyses. Both groups were equal in baseline characteristics and in the duration of index episode treatment. The combined treatment was superior to the monotherapy switch in the MADRS median score reduction (16 vs. 9 points, p=0.01). The combined group achieved higher response rate compared to monotherapy group (67% vs. 36%, p=0.05). Number need to treat for response was 3.3 (95% CI, 1.85-37.3).


CONCLUSIONS
The findings of this study suggest that combined treatment is more efficacious than switch to monotherapy in the treatment of resistant depression.
Bares
Martin
M
Prague Psychiatric Centre, Prague - Bohnice, Czech Republic. bares@pcp.lf3.cuni.cz
Novak
Tomas
T
Kopecek
Miloslav
M
Stopkova
Pavla
P
Sos
Peter
P
D000328:Adult; D000928:Antidepressive Agents / Q000008:administration & dosage*; D003865:Major Depressive Disorder / Q000175:diagnosis / Q000188:drug therapy*; D004351:Drug Resistance; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011569:Psychiatric Status Rating Scales; D012189:Retrospective Studies; D055502:Secondary Prevention; D012720:Severity of Illness Index; D016896:Treatment Outcome
D000928:Antidepressive Agents