title: Combination of agomelatine and bupropion for treatment-resistant depression: results from a chart review study including a matched control group.
abstract: BACKGROUND
  Although a growing selection of antidepressants is available, a significant number of patients do not reach clinical remission, despite multiple trials. Data concerning the efficacy and safety of combination therapies with newer antidepressants are limited.
  
  
  METHODS
  Fifteen inpatients with treatment-resistant depression (TRD), defined as Beck Depression Inventory-2 (BDI-2) scores >14 despite treatment with adequate doses of ≥ 1 antidepressant classes for ≥ 6 weeks, were treated with agomelatine plus bupropion for ≥6 weeks, and compared to 15 patients on antidepressant monotherapy with TRD matched on age, sex, and TRD stage based on retrospective chart review. The primary outcome was change in BDI-2 scores. Secondary outcomes included treatment response (BDI-2 score decrease by ≥ 50%), remission (BDI-2 score <13), routinely measured cardiometabolic parameters and adverse effects.
  
  
  RESULTS
  After a mean of 6 ± 1 weeks, BDI-2 scores decreased by 20.3 ± 5.6 points in the combination group compared to 12.5 ± 15.1 points in the monotherapy group (P = 0.073; Cohen's d = 0.7). Altogether, 73.3% in the combination group responded compared to 53.3% on monotherapy (P = 0.27). About 60.0% on combination therapy reached remission compared to 40% on monotherapy (P = 0.28), a difference equivalent to a number-needed-to-treat = 4. Treatment response was independent of the degree of TRD (P = 0.27). Bupropion-agomelatine cotreatment was well tolerated and laboratory adverse effect parameters were not altered.
  
  
  CONCLUSIONS
  Despite the small sample and uncontrolled study design, the good remission rate in TRD patients receiving agomelatine plus bupropion, particularly in comparison to the monotherapy group, indicates that this combination treatment should be explored further as a potentially promising strategy for patients with TRD.
authors: Department of Neurology, Hannover Medical School Carl-Neuberg-Str. 1, Hannover, 30625, Germany.
authors: Kurt-Wolfram
authors: KW
authors: Sühs
authors: Department of Psychiatry, The Zucker Hillside Hospital Glen Oaks, New York ; Department of Psychiatry and Molecular Medicine, Hofstra North Shore Long Island Jewish School of Medicine Hempstead, New York ; Department of Psychiatry and Behavioral Sciences, Albert Einstein College of Medicine Bronx, New York.
authors: Christoph
authors: C
authors: Correll
authors: Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School Carl-Neuberg-Str. 1, Hannover, 30625, Germany.
authors: Christian K
authors: CK
authors: Eberlein
authors: Department of Neurology, Hannover Medical School Carl-Neuberg-Str. 1, Hannover, 30625, Germany.
authors: Refik
authors: R
authors: Pul
authors: Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School Carl-Neuberg-Str. 1, Hannover, 30625, Germany.
authors: Helge
authors: H
authors: Frieling
authors: Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School Carl-Neuberg-Str. 1, Hannover, 30625, Germany.
authors: Stefan
authors: S
authors: Bleich
authors: Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School Carl-Neuberg-Str. 1, Hannover, 30625, Germany.
authors: Kai G
authors: KG
authors: Kahl
mesh_terms: D000081:Acetamides / Q000008:administration & dosage*; D000328:Adult; D018687:Antidepressive Agents, Second-Generation / Q000008:administration & dosage*; D016642:Bupropion / Q000008:administration & dosage*; D003865:Major Depressive Disorder / Q000188:drug therapy*; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D006993:Hypnotics and Sedatives / Q000008:administration & dosage*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D016896:Treatment Outcome; D009281:Naphthalenes
chemical_list: D000081:Acetamides; D018687:Antidepressive Agents, Second-Generation; D016642:Bupropion; D006993:Hypnotics and Sedatives; C084711:agomelatine; D009281:Naphthalenes
keywords: Agomelatine; bupropion; treatment-resistant depression