Depression treatment in patients with general medical conditions: results from the CO-MED trial.
OBJECTIVE
We studied the effect of 3 antidepressant treatments on outcomes (depressive severity, medication tolerability, and psychosocial functioning) in depressed patients having comorbid general medical conditions in the Combining Medications to Enhance Depression Outcomes (CO-MED) trial.


METHODS
Adult outpatients who had chronic and/or recurrent major depressive disorder (MDD) with and without general medical conditions were randomly assigned in 1:1:1 ratio to 28 weeks of single-blind, placebo-controlled antidepressant treatment with (1) escitalopram plus placebo, (2) bupropion-SR plus escitalopram, or (3) venlafaxine-XR plus mirtazapine. At weeks 12 and 28, we compared response and tolerability between participants with 0, 1, 2, and 3 or more general medical conditions.


RESULTS
Of the 665 evaluable patients, 49.5% reported having no treated general medical conditions, 23.8% reported having 1, 14.8% reported having 2, and 11.9% reported having at least 3. We found only minimal differences in antidepressant treatment response between these groups having different numbers of conditions; patients with 3 or more conditions reported higher rates of impairment in social and occupational functioning at week 12 but not at week 28. Additionally, we found no significant differences between the 3 antidepressant treatments across these groups.


CONCLUSIONS
Patients with general medical conditions can be safely and effectively treated for MDD with antidepressants with no additional adverse effect or tolerability burden relative to their counterparts without such conditions. Combination therapy is not associated with an increased treatment response beyond that found with traditional monotherapy in patients with MDD, regardless of the presence and number of general medical conditions.
Department of Psychiatry, University of Texas Southwestern Medical Center at Dallas, Dallas, Texas 75390-9086, USA. DavidW.Morris@UTSouthwestern.edu
David W
DW
Morris
Nitin
N
Budhwar
Mustafa
M
Husain
Stephen R
SR
Wisniewski
Benji T
BT
Kurian
James F
JF
Luther
Kevin
K
Kerber
A John
AJ
Rush
Madhukar H
MH
Trivedi
D000293:Adolescent; D000328:Adult; D000368:Aged; D018687:Antidepressive Agents, Second-Generation / Q000008:administration & dosage / Q000627:therapeutic use*; D016642:Bupropion / Q000008:administration & dosage / Q000627:therapeutic use; D015283:Citalopram / Q000008:administration & dosage / Q000627:therapeutic use; D015897:Comorbidity; D003511:Cyclohexanols / Q000008:administration & dosage / Q000627:therapeutic use; D003865:Major Depressive Disorder / Q000188:drug therapy* / Q000453:epidemiology; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D010919:Placebos; D016037:Single-Blind Method; D011795:Surveys and Questionnaires; D016896:Treatment Outcome; D000069470:Venlafaxine Hydrochloride; D055815:Young Adult
D018687:Antidepressive Agents, Second-Generation; D003511:Cyclohexanols; D010919:Placebos; D016642:Bupropion; D015283:Citalopram; D000069470:Venlafaxine Hydrochloride