Antidepressant monotherapy compared with combinations of antidepressants in the treatment of resistant depressive patients: A randomized, open-label study

Abstract

Objective. This randomized, 6-week, open-label study compared efficacy of CAD and antidepressant monotherapies (ADM) that had been chosen according to clinical judgment of the attending psychiatrist. Methods. A total of 60 inpatients (intent-to-treat analysis) with depressive disorder (≥ 1 unsuccessful antidepressant treatment) were randomly assigned to the interventions. The responders who completed the acute phase of study, were evaluated for relapse within 2 months of follow-up treatment. The primary outcome measure was change in the Montgomery–Åsberg Depression Rating Scale (MADRS) and response was defined as a ≥ 50% reduction of MADRS score. Results. Mean changes in total MADRS score from baseline to week 6 for patients in both treatment modalities were not different (ADM = 13.2 ± 8.6 points; CAD = 14.5 ± 9.5 points; P = 0.58). The analysis of covariance performed for significantly higher value of imipramine equivalent dose in CAD group showed only a non-significant between-group difference for total MADRS change (P = 0.17). There were also no differences between groups in response rate (ADM = 48%; CAD = 58%) and number of drop-outs in acute treatment as well as proportion of responders’ relapses in the follow-up. Conclusion. Both treatment modalities produced clinically relevant reduction of depressive symptomatology in acute treatment of patients with resistant depression and their effect was comparable.

Key Words::

• Resistant depression
• treatment
• antidepressant monotherapy
• combination of antidepressants

Acknowledgements

The authors thank Ms Kveta Vonaskova and Ms Jolana Sediva for administrative and technical support.

Statement of Interest

This study was supported by a grant from Internal Grant Agency of Ministry of Health of Czech Republic No. NS 10368-3. MB, TN, PS, JC, JK and MK have no conflict of interest. CH: Clinical trials: coordinator of a multicentric study for Servier. Consultant: Advisory board member, Lilly and BMS. Grant: Lilly. Paid lectures for: Lilly, Janssen Cilag, BMS, Medicom, Nycomed, Krka. Other: faculty member, Lundbeck International Neuroscience Foundation.