title: Randomized comparison of selective serotonin reuptake inhibitor (escitalopram) monotherapy and antidepressant combination pharmacotherapy for major depressive disorder with melancholic features: a CO-MED report.
abstract: BACKGROUND
  The clinical effects of antidepressant combinations vs. monotherapy as initial treatment for major depression with melancholic features (MDD-MF) are unknown.
  
  
  METHODS
  Outpatients with chronic or recurrent major depression (MDD) were randomized to initial treatment with escitalopram+placebo (the MONO condition), bupropion-sustained release+escitalopram, or venlafaxine-extended release+mirtazapine (the COMB conditions) in the Combining Medications to Enhance Depression Outcomes (CO-MED) trial. Secondary data analyses were conducted to compare demographic and clinical characteristics, and contrast clinical responses according to drug treatment, in patients with MDD-MF (n=124) and non-melancholic MDD (n=481).
  
  
  RESULTS
  While numerically lower, remission rates in MDD-MF did not differ significantly from those with non-melancholic MDD either at 12 (33.1% vs. 41.0%, aOR 1.16, p=0.58) or 28 (39.5% vs. 46.8%, aOR=1.02, p=0.93) weeks of treatment. Remission rates did not differ significantly between combination and monotherapy groups in either MDD-MF or non-melancholic MDD patients at either time point. Similar conclusions were reached for response rates, premature study discontinuation, and self-rated depression symptom severity.
  
  
  CONCLUSIONS
  This is a secondary analysis of data from the CO-MED trial, which was not designed to address differential treatment response in melancholic and non-melancholic MDD.
  
  
  CONCLUSIONS
  We found no evidence of differential remission or response rates to antidepressant combination or monotherapy between melancholic/non-melancholic MDD patients, or according to antidepressant treatment group, after 12 and 28 weeks. Melancholic features may not be a valid predictor of more favorable response to antidepressant combination therapy as initial treatment.
authors: Department of Psychiatry, Vanderbilt University School of Medicine, Nashville, TN, USA. william.v.bobo@vanderbilt.edu
authors: William V
authors: WV
authors: Bobo
authors: Helen
authors: H
authors: Chen
authors: Madhukar H
authors: MH
authors: Trivedi
authors: Jonathan W
authors: JW
authors: Stewart
authors: Andrew A
authors: AA
authors: Nierenberg
authors: Maurizio
authors: M
authors: Fava
authors: Benji T
authors: BT
authors: Kurian
authors: Diane
authors: D
authors: Warden
authors: David W
authors: DW
authors: Morris
authors: James F
authors: JF
authors: Luther
authors: Mustafa M
authors: MM
authors: Husain
authors: Ian A
authors: IA
authors: Cook
authors: Ira M
authors: IM
authors: Lesser
authors: Susan G
authors: SG
authors: Kornstein
authors: Stephen R
authors: SR
authors: Wisniewski
authors: A John
authors: AJ
authors: Rush
authors: Richard C
authors: RC
authors: Shelton
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