title: Effects of heart disease on depression treatment: results from the COMED study.
abstract: OBJECTIVE
  To determine the impact of self-reported heart disease (HD) on major depressive disorder (MDD) treatment outcomes.
  
  
  METHODS
  This single-blind, 7-month prospective randomized trial enrolled 665 participants, 18-75 years old, from six primary and nine psychiatric care sites across the USA. Participants had at least moderately severe (baseline 17-item Hamilton Rating Scale of Depression ≥16), nonpsychotic chronic and/or recurrent MDD. Participants with and without self-reported HD were randomized into three treatment groups (1:1:1 ratio): escitalopram plus placebo, bupropion sustained-release plus escitalopram or venlafaxine extended-release plus mirtazapine. The primary outcome (remission) was defined by the last two consecutive 16-item Quick Inventory of Depressive Symptomatology-Self-Report (QIDS-SR(16)) ratings: one had to be <8 and one <6. Secondary outcomes included response (reduction in QIDS-SR(16) >50%) side-effect burden, quality of life and functioning. A P value <.05 indicated statistical significance.
  
  
  RESULTS
  Participants with HD were less depressed at baseline and demonstrated fewer side effects at Treatment Weeks 12 and 28. The HD groups did not differ regarding remission [40.0% (16/40) vs. 38.2% (239/625), P=.5566] or response [50% (20/40) vs. 52.1% (314/625), P=.8055].
  
  
  CONCLUSIONS
  Despite apparent baseline and side-effect differences between participants with and without HD, the two groups did not differ regarding MDD treatment outcomes.
authors: Department of Psychiatry, University of Michigan, Ann Arbor, MI 48109, USA. kkerber@umich.edu
authors: Kevin Brian
authors: KB
authors: Kerber
authors: Stephen R
authors: SR
authors: Wisniewski
authors: James F
authors: JF
authors: Luther
authors: Andrew F
authors: AF
authors: Leuchter
authors: Inna
authors: I
authors: D'Empaire
authors: Madhukar H
authors: MH
authors: Trivedi
authors: A John
authors: AJ
authors: Rush
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D015897:Comorbidity; D003865:Major Depressive Disorder / Q000188:drug therapy*; D005260:Female; D006331:Heart Diseases; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D055815:Young Adult