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Factors Associated with Concomitant Psychotropic Drug Use in the Treatment of Major Depression: A STAR*D Report

  • Richard C. Shelton, Steve D. Hollon, Stephen R. Wisniewski, Jonathan E. Alpert, G.K. Balasubramani, Edward S. Friedman, A. John Rush, Madhukar H. Trivedi and Sheldon H. Preskorn...

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.

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Corresponding author

1500 21st Avenue, South, Suite 2200, Nashville, TN, 37212; Tel: 615-343-9669, Fax: 615-343-7868; e-mail: richard.shelton@vanderbilt.edu.

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Factors Associated with Concomitant Psychotropic Drug Use in the Treatment of Major Depression: A STAR*D Report

  • Richard C. Shelton, Steve D. Hollon, Stephen R. Wisniewski, Jonathan E. Alpert, G.K. Balasubramani, Edward S. Friedman, A. John Rush, Madhukar H. Trivedi and Sheldon H. Preskorn...

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