TY - JOUR
T1 - Factors associated with concomitant psychotropic drug use in the treatment of major depression
T2 - A STAR*D report
AU - Shelton, Richard C.
AU - Hollon, Steve D.
AU - Wisniewski, Stephen R.
AU - Alpert, Jonathan E.
AU - Balasubramani, G. K.
AU - Friedman, Edward S.
AU - Rush, A. John
AU - Trivedi, Madhukar H.
AU - Preskorn, Sheldon H.
N1 - Copyright:
Copyright 2017 Elsevier B.V., All rights reserved.
PY - 2009
Y1 - 2009
N2 - 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.
AB - 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.
UR - http://www.scopus.com/inward/record.url?scp=70849120686&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=70849120686&partnerID=8YFLogxK
U2 - 10.1017/S1092852900023555
DO - 10.1017/S1092852900023555
M3 - Article
C2 - 19890231
AN - SCOPUS:70849120686
SN - 1092-8529
VL - 14
SP - 487
EP - 498
JO - CNS spectrums
JF - CNS spectrums
IS - 9
ER -