Treatment response to antidepressants similar in MDD patients with and without medical comorbidities

In patients with major depressive disorder (MDD) and general medical conditions, the use of antidepressants was safe and effective compared to patients without such conditions. Combination therapy was no different than monotherapy, regardless of the number of comorbidities present, according to the recent findings of a new randomized, single-blind, placebo-controlled trial published in The Annals of Family Medicine.

In this trial, called CO-MED (Combining Medications to Enhance Depression Outcomes), researchers randomly assigned patients to receive escitalopram + placebo, bupropion-SR + escitalopram, or venlafaxine-XR + mirtazapine. Patients had to be diagnosed with recurrent or chronic non-psychotic MDD with the index episode lasting ≥2 months and score of at least 16 on the 17-item Hamilton Rating Scale for Depression. General medical conditions were self-reported and included if the condition was currently being treated and medically stable per the primary physician. Patients were stratified by the number of conditions present (0, 1, 2, or ≥3) and comparisons were made to patients without such conditions. Analyses were adjusted for treatment, age, education, employment, age at first episode, body mass index, and systolic blood pressure.

A total of 665 patients were enrolled and the majority reported no medical conditions (49.5%), followed by 1 (23.8%), 2 (14.8%), and ≥3 conditions (11.9%). After adjustment for confounders, patients with ≥3 conditions had an increased odds of impaired social and occupational function at 12 weeks [adjusted odds ratio (AOR)=2.17; P<.0083] but not at 28 weeks [AOR=1.49; P=.48]. No differences in symptom severity or tolerability were seen between the groups. There were no statistically significant differences in early termination, remission, response, or tolerability between the treatment groups regardless of the number of general medical conditions.

Researchers noted several study limitations including limited statistical power to detect differences between medical condition groups and their self-reported nature, exclusion of patients with unstable or untreated medical conditions, and use of FDA-approved dosing as higher dosing could lead to a different response.

This trial was funded by the National Institute of Mental Health.

SOURCE

Morris DW, Budhwar N, Husain M, et al. ­Depression treatment in patients with general medical conditions: Results from the CO-MED trial. Annals of Family Medicine. 2012;10:23–33.