Patients with major
Depressive disorder could be safely and efficiently treated with antidepressants
even though they have multiple comorbid medical conditions, investigation of a new trial
There were no differences in rates of remission at 28 weeks among
Patients with no comorbidities and depression, and those with three or more
conditions such as hypertension,
diabetes, and arthritis, according to David W. Morris, PhD, of the University
of Texas Southwestern Medical Center in Dallas, and colleagues.
In addition, no differences were seen in social functioning or and work
side effect burden after six months of treatment, the researchers reported
online in the Annals of Family Medicine.
Previous studies have
suggested the presence of comorbid medical conditions may interfere with
Treating depression, and that patients with medical ailments may not
React satisfactorily to antidepressants.
To investigate these concerns
More fully, Morris and colleagues examined data from a study, known as COMED, which compared different and outcomes
Combinations of antidepressants and personalized dose titration.
The specific regimens were:
- Treatment with the selective serotonin reuptake inhibitor (SSRI) escitalopram (Lexapro) starting at doses of 10 mg/day with escalation as born to a maximum of 20 mg/day.
- Escitalopram plus the dopamine-norepinephrine modulator bupropion (Wellbutrin) starting with 150 mg/day and titrated up to a maximum of 400 mg/day.
- Use of the serotonin-norepinephrine reuptake inhibitor venlafaxine (Effexor) starting at 37.5 mg/day with a maximum of 300 mg/day, plus the tetracyclic agent mirtazapine (Remeron) in doses ranging from 15 mg to 45 mg/day.
Of the 665 patients
Registered in the research, 11.9 percent had three or more comorbid medical conditions,
14.8 percent had two, 23.8 had one, and 49.5 percent had none.
included a larger frequency of three or more comorbidities in African American
Patients, increased frequency of multiple states fewer, with age
Comorbidities in patients with higher educational accomplishment, and more common
treatment in primary care, rather than psychiatric settings, for those with
Patients with more or three
Comorbidities were more likely to possess persistent major depression, significance
that symptoms were present for at least two years.
At week 12, patients with
Three or even more comorbidities had lower levels of occupational and social
functioning, a difference that was no longer important at week 28.
No other differences were
Seen at either 28 or weeks 12 in symptom severity, severity or frequency of
Adverse effects, or performance in individuals with multiple concurrent illnesses.
There were no
differences between monotherapy and combination treatment in rates of remission or
side effect burden at week 28.
The “nearly whole
Dearth of statistical differences in outcome measures” between patients with
and without comorbidities implies that antidepressant treatment is effective
And safe for patients with serious physical ailments, according to the
The finding that a greater
number of medical conditions was associated with chronic depression indicates
that a weight of
Physical ailment may contribute to a burden that is psychiatric that is higher,
according to the researchers.
Additionally, the study
When compared, found no difference in safety or effectiveness for combination treatment
with treatment, despite the bigger weight of psychiatric disease.
Guidelines for patients with general medical conditions and longstanding or
recurrent depression are lacking, the top clinical conclusion could be to begin
treatment with SSRI monotherapy given a a priori evaluation of called
compatibility with concomitant medications, and then proceed to a trial of combination
Drugs as needed,” Morris and colleagues wrote.
Limits of the study
included the self-report of medical comorbidities, a dearth of blinding among
Treating researchers and physicians, and the exception of patients with serious
or unsound medical conditions.
Within an editorial
accompanying the study, Elizabeth A. Bayliss, MD, of Kaiser Permanente in
Denver, noted that the current arrangement for compensation derives from a
disease-specific outlook, which may change having a larger emphasis on patient-centered
“With this particular shift, it
May become not only medically right but also fiscally possible to
Execute effective integrated and multidimensional care direction for individuals
with depression as well as other chronic medical conditions,” Bayliss predicted.