Citation

Shelton RC, Hollon SD, Wisniewski SR, Alpert JE, Balasubramani GK, Friedman ES, Rush AJ, Trivedi MH, Preskorn SH. CNS Spectr. 2009; 14(9): 487-498.

Affiliation

Department of Psychiatry, Vanderbilt University, Nashville, TN 37212, USA.

Copyright

(Copyright © 2009, MBL Communications)

DOI

unavailable

PMID

19890231

Abstract

INTRODUCTION: Concomitant psychotropic medication (CPM) treatment is common in persons with major depression (MDD). However, relationships with patient characteristics and response to treatment are unclear. METHODS: Participants with nonpsychotic MDD (N=2682) were treated with citalopram, 20-60 mg/day. Sociodemographic, clinical, and treatment outcome characteristics were compared between those using CPMs at study entry or during up to 14 weeks of citalopram treatment, and non-users. RESULTS: About 35% of participants used a CPM. Insomnia was the predominant indication (70.3%). CPM users were more likely to be seen in primary care settings (69.3% versus 30.7%), be white, of non-Hispanic ethnicity, married, and have a higher income, private insurance, and certain comorbid disorders. CPM users had greater depressive severity, poorer physical and mental functioning, and poorer quality of life than non-users. Response and remission rates were also lower. CPM users were more likely to achieve >50 mg/day of citalopram, to report greater side effect intensity, and to have serious adverse events, but less likely to be intolerant of citalopram. CONCLUSION: CPMs are associated with greater illness burden, more Axis I comorbidities (especially anxiety disorders), and lower treatment effectiveness. This suggests that CPM use may identify a more difficult to treat population that needs more aggressive treatment.

Language: en