The impact of chronic depression on acute and long-term outcomes in a randomized trial comparing selective serotonin reuptake inhibitor monotherapy versus each of 2 different antidepressant medication combinations

Abstract

Objective: To compare sociodemographic and clinical features, acute and continuation treatment outcomes, and adverse events/side effect burden between outpatients with chronic (current episode > 2 years) versus nonchronic major depressive disorder (MDD) who were treated with combination antidepressant therapy or selective serotonin reuptake inhibitor (SSRI) monotherapy. Method: 663 outpatients with chronic (n = 368) or nonchronic (n = 295) moderate to severe DSM-IV-TR MDD (17-item Hamilton Depression Rating Scale score ≥ 16) were enrolled from March 2008 through September 2009 in a single-blind 7-month prospective randomized trial conducted at 6 primary and 9 psychiatric care sites across the United States. Participants were treated with escitalopram monotherapy plus placebo or 1 of 2 combination treatments (bupropion sustained-release [SR] + escitalopram or venlafaxine extended-release [XR] + mirtazapine). Analyses compared baseline sociodemographic and clinical characteristics, rates of remission (at least 1 of the last 2 consecutive scores on the 16-item Quick Inventory of Depressive Symptomatology-Self-Report [QIDS-SR₁₆] < 6, with the other < 8), and adverse events/side effect burden (Frequency, Intensity, and Burden of Side Effects Ratings) obtained at 12 and 28 weeks. Results: Participants with chronic MDD were at greater socioeconomic disadvantage and had greater medical and psychiatric disease burden. The chronic and nonchronic groups did not differ in rates of remission at 12 weeks (35.9% vs 42.0%, respectively; odds ratio [OR] = 0.778, P = .1500; adjusted OR [AOR] = 0.956, P = .8130) or at 28 weeks (41.0% vs 49.8%, respectively; OR = 0.706, P = .0416; AOR = 0.837, P = .3448). Participants with chronic MDD had higher final QIDS-SR₁₆ scores and smaller overall percent changes in QIDS-SR₁₆ from baseline to exit, but these differences did not remain after adjusting for covariates. There were no significant differences in adverse events or side effect burden. No significant interactions were found between chronicity and type of treatment at 12 or 28 weeks. Conclusion: Chronicity of illness does not appear to differentially impact acute or longer-term outcomes with SSRI monotherapy or combination antidepressant medication treatment in patients with moderate to severe nonpsychotic MDD. (PsycInfo Database Record (c) 2020 APA, all rights reserved)

Accession Number: 2013-12831-006. PMID: 22687487 Other Journal Title: Diseases of the Nervous System. Partial author list: First Author & Affiliation: Sung, Sharon C.; Duke-NUS Graduate Medical School, Singapore, sharon.sung@duke-nus.edu.sg. Institutional Authors: CO-MED Study Team. Release Date: 20131104. Correction Date: 20200813. Publication Type: Journal (0100), Peer Reviewed Journal (0110). Format Covered: Electronic. Document Type: Journal Article. Language: English. Grant Information: Rush, A. John. Major Descriptor: Drug Therapy; Major Depression; Serotonin Reuptake Inhibitors; Side Effects (Drug); Treatment Outcomes. Minor Descriptor: Antidepressant Drugs; Chronicity (Disorders); Demographic Characteristics. Classification: Clinical Psychopharmacology (3340). Population: Human (10); Male (30); Female (40); Outpatient (60). Location: US. Age Group: Adulthood (18 yrs & older) (300); Young Adulthood (18-29 yrs) (320); Thirties (30-39 yrs) (340); Middle Age (40-64 yrs) (360); Aged (65 yrs & older) (380). Tests & Measures: DSM-IV Major Depressive Disorder Symptom Checklist; Self-Administered Comorbidity Questionnaire; Quick Inventory of Depressive Symptomatology-Self-Rated; Inventory of Depressive Symptomatology-Clinician-Rated; Concise Health Risk Tracking Scale-Self-Rated; Altman Self-Rated Mania Scale; Frequency, Intensity, and Burden of Side Effects Ratings; Systematic Assessment for Treatment Emergent Events-Systematic Inquiry; Psychiatric Diagnostic Screening Questionnaire DOI: 10.1037/t14762-000; Work and Social Adjustment Scale DOI: 10.1037/t77117-000; Quality of Life Inventory DOI: 10.1037/t03748-000; Hamilton Rating Scale for Depression DOI: 10.1037/t04100-000. Methodology: Empirical Study; Longitudinal Study; Prospective Study; Quantitative Study; Treatment Outcome. References Available: Y. Page Count: 10. Issue Publication Date: Jul, 2012. Publication History: Accepted Date: Jan 5, 2012; First Submitted Date: Apr 4, 2011. Copyright Statement: Physicians Postgraduate Press, Inc. 2012.