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Original Research

Optimized regimens of combined medications for the treatment of major depressive disorder: a double-blind, randomized-controlled trial

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Pages 3209-3218 | Published online: 22 Nov 2018

Figures & data

Table 1 Patient demographics at the Royal Institute of Mental Health Research in a double-blind randomized trial of antidepressant monotherapy vs combination treatment, using escitalopram and bupropion in major depressive disorder patients

Figure 1 Patient enrollment at the Royal Institute of Mental Health Research in a double-blind, randomized trial of antidepressant monotherapy vs combination treatment, using escitalopram and bupropion in major depressive disorder patients.

Abbreviations: AE, adverse effect; LTF, lost to follow-up; WC, withdrawn consent.
Figure 1 Patient enrollment at the Royal Institute of Mental Health Research in a double-blind, randomized trial of antidepressant monotherapy vs combination treatment, using escitalopram and bupropion in major depressive disorder patients.

Figure 2 Mean scores on the HAM-D17 (0–42) by week, for all major depressive disorder patients (last observation carried forward) during 12 weeks of initial treatment at the Royal Institute of Mental Health Research in a double-blind, randomized trial of antidepressant monotherapy vs combination treatment, using escitalopram and bupropion.

Note: Statistically significant difference existed in week 1 between the combination treatment and bupropion monotherapy in antidepressant response (LSD, P=0.022).
Abbreviations: HAM-D 17, 17-item Hamilton Rating Scale for Depression; LSD, least significant difference.
Figure 2 Mean scores on the HAM-D17 (0–42) by week, for all major depressive disorder patients (last observation carried forward) during 12 weeks of initial treatment at the Royal Institute of Mental Health Research in a double-blind, randomized trial of antidepressant monotherapy vs combination treatment, using escitalopram and bupropion.

Figure 3 Percentage of remission on the HAM-D17 (≤7) by week, for all major depressive disorder patients (last observation carried forward) during 12 weeks of initial treatment at the Royal Institute of Mental Health Research in a double-blind randomized trial of antidepressant monotherapy vs combination treatment, using escitalopram and bupropion.

Note: Statistically significant differences existed in week 2 between the combination arm and both monotherapies, ie, 5 vs 0 on bupropion (Fisher’s Exact test, P=0.031) and 0 on escitalopram (Fisher’s Exact test, P=0.020).
Abbreviation: HAM-D 17, 17-item Hamilton Rating Scale for Depression.
Figure 3 Percentage of remission on the HAM-D17 (≤7) by week, for all major depressive disorder patients (last observation carried forward) during 12 weeks of initial treatment at the Royal Institute of Mental Health Research in a double-blind randomized trial of antidepressant monotherapy vs combination treatment, using escitalopram and bupropion.

Figure 4 Percentage of remission on the MADRS (≤10) by week, for all major depressive disorder patients (last observation carried forward) during 12 weeks of initial treatment at the Royal Institute of Mental Health Research in a double-blind randomized trial of antidepressant monotherapy vs combination treatment, using escitalopram and bupropion.

Note: The week 12 remission rate of the combination treatment on MADRS was not significantly different from escitalopram or bupropion monotherapies (P=0.38 and P=0.15, respectively).
Abbreviation: MADRS, Montgomery–Asberg Depression Rating Scale.
Figure 4 Percentage of remission on the MADRS (≤10) by week, for all major depressive disorder patients (last observation carried forward) during 12 weeks of initial treatment at the Royal Institute of Mental Health Research in a double-blind randomized trial of antidepressant monotherapy vs combination treatment, using escitalopram and bupropion.

Table 2 Mean scores on the HAM-D17 (0–42) in a double-blind, 6-week augmentation trial in escitalopram or bupropion monotherapy non-remitters who received augmentation with the other drug, and in escitalopram and bupropion combination non-remitters who switched escitalopram for duloxetine (last observation carried forward)

Figure 5 Mean scores on the HAM-D17 (0–42) in a double-blind, 6-week augmentation trial in escitalopram or bupropion monotherapy non-remitters who received augmentation with the other drug, and in escitalopram and bupropion combination non-remitters who switched escitalopram for duloxetine (last observation carried forward).

Note: The mean score of remitters was lower than of non-remitters both at baseline and week 6 (F(1, 24)=4.50, P=0.044, and F(1, 24)=20.45, P<0.001, respectively).
Abbreviation: HAM-D 17, 17-item Hamilton Rating Scale for Depression.
Figure 5 Mean scores on the HAM-D17 (0–42) in a double-blind, 6-week augmentation trial in escitalopram or bupropion monotherapy non-remitters who received augmentation with the other drug, and in escitalopram and bupropion combination non-remitters who switched escitalopram for duloxetine (last observation carried forward).

Figure 6 Mean scores on the HAM-D17 (0–42) in a double-blind 6-month prolongation in week 12 initial treatment and week 6 augmentation remitters (last observation carried forward) on antidepressant monotherapy or combination treatment, using escitalopram and bupropion.

Abbreviation: HAM-D 17, 17-item Hamilton Rating Scale for Depression.
Figure 6 Mean scores on the HAM-D17 (0–42) in a double-blind 6-month prolongation in week 12 initial treatment and week 6 augmentation remitters (last observation carried forward) on antidepressant monotherapy or combination treatment, using escitalopram and bupropion.

Figure 7 Mean scores on the Q-LES-Q-SF (0–80) for all patients (last observation carried forward) enrolled in a randomized, double-blind 12-week trial of antidepressant monotherapy vs combination treatment, including a double-blind 6-week augmentation in non-remitters, and a double-blind 6-month prolongation in both week 12 and week 18 remitters.

Abbreviation: Q-LES-Q-SF, Quality of Life Enjoyment and Satisfaction Questionnaire-short form.
Figure 7 Mean scores on the Q-LES-Q-SF (0–80) for all patients (last observation carried forward) enrolled in a randomized, double-blind 12-week trial of antidepressant monotherapy vs combination treatment, including a double-blind 6-week augmentation in non-remitters, and a double-blind 6-month prolongation in both week 12 and week 18 remitters.