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Dual Depression Medications Increase Costs, Side Effects With No Benefit

Taking two medications for depression does not hasten recovery from the condition that affects 19 million Americans each year, researchers at University of Texas Southwestern Medical Center have found in a national study.

“Clinicians should not rush to prescribe combinations of antidepressant medications as first-line treatment for patients with major depressive disorder,” says Madhukar H. Trivedi, MD, a psychiatry professor and chief of the division of mood disorders at Southwestern and principal investigator of the study, which is available online in the American Journal of Psychiatry.

“The clinical implications are very clear—the extra cost and burden of two medications is not worthwhile as a first treatment step,” he says.

In the Combining Medication to Enhance Depression Outcomes study, researchers at 15 sites across the country studied 665 patients ages 18 to 75 with major depressive disorder. Three treatment groups were formed and prescribed antidepressant medications already approved by the FDA. One group received escitalopram (a selective serotonin reuptake inhibitor [SSRI]) and a placebo; the second group received the same SSRI paired with bupropion (a nontricyclic antidepressant); and a third group took different antidepressants: venlafaxine (a tetracyclic antidepressant) and mirtazapine (a serotonin norepinephrine reuptake inhibitor). The study was conducted from March 2008 through February 2009.

After 12 weeks of treatment, remission and response rates were similar across the three groups: 39%, 39%, and 38%, respectively, for remission, and about 52% in all three groups for response. After seven months of treatment, remission and response rates across the three groups remained similar, but side effects were more frequent in the third group.

The next step, Trivedi says, is to study biological markers of depression to see if researchers can predict response to antidepressant medication and, thus, improve overall outcomes.

— Source: University of Texas Southwestern Medical Center