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J Psychiatr Res. 2014 May;52:7-14. doi: 10.1016/j.jpsychires.2013.12.001. Epub 2013 Dec 17.

Combination antidepressant therapy for major depressive disorder: speed and probability of remission.

Author information

1
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.
2
Columbia University College of Physicians and Surgeons, New York, NY, USA; New York State Psychiatric Institute, New York, NY, USA.
3
Royal Ottawa Mental Health Care Center, Ottawa, Ontario, Canada.
4
New York State Psychiatric Institute, New York, NY, USA.
5
Centre Hospitalier Pierre Janet, Gatineau, Québec, Canada.

Abstract

INTRODUCTION:

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.

METHOD:

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.

DISCUSSION:

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

CLINICAL TRIALS REGISTRATION:

NCT00519428.

KEYWORDS:

Bupropion; Combination treatment; Escitalopram; Major depression; Remission

[Indexed for MEDLINE]

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