Combination antidepressant therapy for major depressive disorder: speed and probability of remission.
BACKGROUND
Only about a third of patients with an episode of major depressive disorder remit with a given treatment and few remissions occur within the first weeks of treatment. This study tested whether combining escitalopram and bupropion as initial treatment would result in quicker remission and a higher remission rate than monotherapy with either drug.


METHODS
Two hundred forty-five outpatients aged 18-65 having non-psychotic, non-bipolar major depression were randomly assigned to double-blind treatment with bupropion or escitalopram or the combination dosed to a maximum of bupropion 450 mg/d and/or escitalopram 40 mg/d for 12 weeks. A Montgomery-Asberg Depression Rating Scale score of 22 was required for randomization, while a Hamilton Rating Scale for Depression score ≤ 7 defined remission. We hypothesized that bupropion plus escitalopram would outperform both monotherapies in both earlier onset of remission and higher rate of remission.


RESULTS
Primary analyses did not demonstrate that dual therapy outperformed both monotherapies in either timing of remission or remission rate. All three treatments were well tolerated.


CONCLUSIONS
These results do not support initial use of bupropion plus escitalopram to speed or enhance antidepressant response.


BACKGROUND
NCT00519428.
Columbia University College of Physicians and Surgeons, New York, NY, USA; New York State Psychiatric Institute, New York, NY, USA. Electronic address: jws6@columbia.edu.
Jonathan W
JW
Stewart
Columbia University College of Physicians and Surgeons, New York, NY, USA; New York State Psychiatric Institute, New York, NY, USA.
Patrick J
PJ
McGrath
Royal Ottawa Mental Health Care Center, Ottawa, Ontario, Canada.
Claude
C
Blondeau
New York State Psychiatric Institute, New York, NY, USA.
Deborah A
DA
Deliyannides
Columbia University College of Physicians and Surgeons, New York, NY, USA; New York State Psychiatric Institute, New York, NY, USA.
David
D
Hellerstein
Royal Ottawa Mental Health Care Center, Ottawa, Ontario, Canada.
Sandhaya
S
Norris
Columbia University College of Physicians and Surgeons, New York, NY, USA; New York State Psychiatric Institute, New York, NY, USA.
Jose
J
Amat
Columbia University College of Physicians and Surgeons, New York, NY, USA; New York State Psychiatric Institute, New York, NY, USA.
Daniel J
DJ
Pilowsky
Royal Ottawa Mental Health Care Center, Ottawa, Ontario, Canada.
Pierre
P
Tessier
Centre Hospitalier Pierre Janet, Gatineau, Québec, Canada.
Louise
L
Laberge
New York State Psychiatric Institute, New York, NY, USA.
Donna
D
O'Shea
New York State Psychiatric Institute, New York, NY, USA.
Ying
Y
Chen
New York State Psychiatric Institute, New York, NY, USA.
Amy
A
Withers
Centre Hospitalier Pierre Janet, Gatineau, Québec, Canada.
Richard
R
Bergeron
Royal Ottawa Mental Health Care Center, Ottawa, Ontario, Canada.
Pierre
P
Blier
D000293:Adolescent; D000328:Adult; D000368:Aged; D000704:Analysis of Variance; D000928:Antidepressive Agents / Q000009:adverse effects*; D016642:Bupropion / Q000009:adverse effects*; D002170:Canada; D015283:Citalopram / Q000009:adverse effects*; D003865:Major Depressive Disorder / Q000188:drug therapy* / Q000453:epidemiology; D004305:Dose-Response Relationship, Drug; D004311:Double-Blind Method; D004359:Drug Therapy, Combination; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011569:Psychiatric Status Rating Scales; D012008:Recurrence; D016896:Treatment Outcome; D014481:United States; D055815:Young Adult
D000928:Antidepressive Agents; D016642:Bupropion; D015283:Citalopram
Bupropion; Combination treatment; Escitalopram; Major depression; Remission