title: Effects of race and ethnicity on depression treatment outcomes: the CO-MED trial.
abstract: OBJECTIVE
  The investigators examined whether outcomes differ by race-ethnicity for patients with major depressive disorder in acute- (12 weeks) and continuation-phase (weeks 12-28) treatment with one of two antidepressant combinations or one selective serotonin reuptake inhibitor.
  
  
  METHODS
  This single-blind, seven-month prospective, randomized trial enrolled 352 non-Hispanic white (59%), 169 black (28%), and 79 white Hispanic (13%) participants from six primary and nine psychiatric care U.S. sites. Patients had nonpsychotic chronic or recurrent major depressive disorder (or both) of at least moderate severity. Escitalopram plus placebo, bupropion sustained-release plus escitalopram, or venlafaxine extended-release plus mirtazapine were delivered according to measurement-based care. The primary outcome was remission (last two consecutive 16-item Quick Inventory of Depressive Symptomatology-Self-Report ratings <8 and <6); secondary outcomes included side effects, adverse events, quality of life, function, and attrition.
  
  
  RESULTS
  Black participants had greater baseline psychiatric and medical comorbidity. Baseline depression severity did not significantly differ between groups. In both phases more blacks than those in other groups exited the trial early. There were only minor differences in side effects, no significant differences in remission rates, and no significant differences between groups in other outcomes for each treatment.
  
  
  CONCLUSIONS
  Despite differences in sociodemographic characteristics and comorbidities, when measurement-based care was used, members of different minority groups had similar outcomes when treated with one antidepressant or a combination of two antidepressants. Black participants had the highest attrition rate, an important issue to address in clinical care.
authors.affiliation: Department of Psychiatry, Harbor-UCLA Medical Center, Torrance, CA, USA. ilesser@labiomed.org
authors.forename: Ira M
authors.initials: IM
authors.lastname: Lesser
authors.forename: Sidney
authors.initials: S
authors.lastname: Zisook
authors.forename: Bradley N
authors.initials: BN
authors.lastname: Gaynes
authors.forename: Stephen R
authors.initials: SR
authors.lastname: Wisniewski
authors.forename: James F
authors.initials: JF
authors.lastname: Luther
authors.forename: Maurizio
authors.initials: M
authors.lastname: Fava
authors.forename: Ahsan
authors.initials: A
authors.lastname: Khan
authors.forename: Patrick
authors.initials: P
authors.lastname: McGrath
authors.forename: Diane
authors.initials: D
authors.lastname: Warden
authors.forename: A John
authors.initials: AJ
authors.lastname: Rush
authors.forename: Madhukar
authors.initials: M
authors.lastname: Trivedi
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000928:Antidepressive Agents / Q000627:therapeutic use; D044383:Black People / Q000523:psychology; D015897:Comorbidity; D003865:Major Depressive Disorder / Q000188:drug therapy* / Q000208:ethnology*; D005260:Female; D006801:Humans; D008297:Male; D008605:Mental Health Services; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D011446:Prospective Studies; D012720:Severity of Illness Index; D055815:Young Adult
chemical_list: D000928:Antidepressive Agents