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

Stewart, Jonathan W.; McGrath, Patrick J.; Blondeau, Claude; Deliyannides, Deborah A.; Hellerstein, David J.; Norris, Sandhaya; Amat, José; Pilowsky, Daniel J.; Tessier, Pierre; Laberge, Louise; O'Shea, Donna; Chen, Ying; Withers, Amy; Bergeron, Richard; Blier, Pierre

doi:10.1016/j.jpsychires.2013.12.001

Cited by 31 publications

(38 citation statements)

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“…112 Combinations of antidepressants have also been investigated as comedications in the initial treatment of MDD. While initial pilot studies were encouraging, 113,114 largesample RCTs found no differences in efficacy with the combination of bupropion þ escitalopram over each agent alone 115 or with the combinations of escitalopram þ bupropion SR and mirtazapine þ venlafaxine XR over escitalopram alone. 116 In addition, adverse effects were higher in the combination treatments.…”

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confidence: 99%

Canadian Network for Mood and Anxiety Treatments (CANMAT) 2016 Clinical Guidelines for the Management of Adults with Major Depressive Disorder

et al. 2016

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Background: The Canadian Network for Mood and Anxiety Treatments (CANMAT) conducted a revision of the 2009 guidelines by updating the evidence and recommendations. The scope of the 2016 guidelines remains the management of major depressive disorder (MDD) in adults, with a target audience of psychiatrists and other mental health professionals. Methods: Using the question-answer format, we conducted a systematic literature search focusing on systematic reviews and meta-analyses. Evidence was graded using CANMAT-defined criteria for level of evidence. Recommendations for lines of treatment were based on the quality of evidence and clinical expert consensus. ''Pharmacological Treatments'' is the third of six sections of the 2016 guidelines. With little new information on older medications, treatment recommendations focus on second-generation antidepressants.Results: Evidence-informed responses are given for 21 questions under 4 broad categories: 1) principles of pharmacological management, including individualized assessment of patient and medication factors for antidepressant selection, regular and

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confidence: 99%

Canadian Network for Mood and Anxiety Treatments (CANMAT) 2016 Clinical Guidelines for the Management of Adults with Major Depressive Disorder

et al. 2016

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“…Despite finding low remission rates in HDRS-17 (28.21% in IPC group and 22.50% in E-TAU group), it is known that only about a third of patients with an episode of MDD may remit with a given treatment [61]. Although IPC is proven to be more efficacious than selective serotonin reuptake inhibitors (SSRIs) in primary care patients with mild to moderate depression [27], in our sample 40.70% exhibited severe to very severe depression according to HDRS-17 (≥19) and also responded to treatment.…”

Section: Discussionmentioning

confidence: 99%

Task shifting interpersonal counseling for depression: a pragmatic randomized controlled trial in primary care

et al. 2017

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BackgroundTask shifting approaches (rational redistribution of tasks among health workforce teams) to train lay professionals to assist with integrating mental health treatment in primary care has been recommended to close the mental health treatment gap for depression in low- and middle-income countries. This study aims to examine the a new model for depression care in a low-resource environment compared to enhanced treatment at usual (E-TAU).MethodsWe trained non-specialist community health workers (local lay employees of the public health system) to provide Interpersonal Counseling (IPC) to treat depressive symptoms in the Brazilian, São Paulo city, family health strategy (FHS). We conducted a randomized controlled trial involving 86 patients with a current major depressive disorder or dysthymia (based on DSM-IV) recruited from an FHS clinic. Participants were randomized to IPC intervention (n = 43) or E-TAU (n = 43). Participants allocated to IPC received 3–4 sessions provided by community health workers; research psychologists followed the E-TAU participants to facilitate their referral to specialized mental health care within the public system. Reduction of depressive symptoms was assessed using the Hamilton Rating Scale (HDRS-17) and the Patient Health Questionnaire (PHQ-9); minor psychiatric symptomatology (including depression, anxiety and somatoform symptoms) were measured using the Self Reporting Questionnaire (SRQ); and functioning was measured by the Clinical Global Impression Scale over a 2-month period.ResultsIntention-to-treat analysis showed significant improvement on symptoms for both groups over 2 months, without significant differences between them. Per-protocol analysis showed significant better HDRS-17 outcomes for the IPC group.ConclusionsTraining non-specialist community health workers in low- and middle-income countries to provide IPC could be a successful strategy in reducing the burden of depression and also potentially a low-cost and effective alternative to specialist-led services that might not be possible in low income settings.Trial registrationBrazilian Clinical Trials, number RBR-5qhmb5 (trial url: http://www.ensaiosclinicos.gov.br/rg/RBR-5qhmb5/), retrospectively registered after May 1, 2013.

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“…There is little in the literature describing the effects of antidepressants in the first week, but there is evidence of benefit within the first 2 weeks of therapy (Shiffman et al, 2000; Stewart et al, 2014), even though maximal clinical effects are noted 4 to 6 weeks after initiation (Posternak & Zimmerman, 2005). Previous research has shown that bupropion SR mitigates depressive symptoms stemming from nicotine withdrawal as soon as 14 days after initiation of treatment (Shiffman, et al, 2000).…”

Section: Discussionmentioning

confidence: 99%

Depressive Symptoms Among Patients Receiving Varenicline and Bupropion for Smoking Cessation

Hong¹,

Elrashidi²,

Schroeder³

et al. 2015

Journal of Substance Abuse Treatment

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While the combination therapy of varenicline and sustained release bupropion (bupropion SR) for cigarette smoking cessation can increase smoking abstinence rates, it has also been associated with increases in self-reported depressive symptoms. We conducted an analysis of the Beck Depression Inventory, second edition (BDI-II), data completed by 505 patients from a large randomized clinical trial, evaluating the efficacy of 12 weeks of combination therapy (varenicline + bupropion SR) compared to varenicline alone. At medication treatment week 2 (1 week after target quit date [TQD]), increased depressive symptoms were observed in patients receiving combination therapy (effect estimate = 0.61, 95% CI [0.03, 1.19], P=.039) and those with a history of depression (effect estimate = 0.82, 95% CI [0.07, 1.57], P=.033). For treatment weeks 2 to 4, smokers with a history of depression on combination therapy had a greater decline in depressive symptoms compared to those on varenicline alone (effect estimate = –1.99, 95% CI [–3.99, 0.00], P=.050). After treatment week 4, no significant effects of treatment or depression history on BDI-II scores were observed. A history of depression did not moderate the efficacy of combination therapy for smoking abstinence. Our study suggests that for combination therapy with varenicline and bupropion SR, an increase in depressive symptoms over the first 2 weeks may be observed; however, the effects on depressive symptoms do not last beyond 4 weeks. We conclude that among smokers without active moderate or severe depression, the decision to use this combination treatment approach should not be based upon a self-reported history of depression.

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

Cited by 31 publications

References 25 publications

Canadian Network for Mood and Anxiety Treatments (CANMAT) 2016 Clinical Guidelines for the Management of Adults with Major Depressive Disorder

Canadian Network for Mood and Anxiety Treatments (CANMAT) 2016 Clinical Guidelines for the Management of Adults with Major Depressive Disorder

Task shifting interpersonal counseling for depression: a pragmatic randomized controlled trial in primary care

Depressive Symptoms Among Patients Receiving Varenicline and Bupropion for Smoking Cessation

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