Article Figures & Data
Tables
No. of General Medical Conditions Between-Group Comparison Characteristic 0 (n = 328) 1 (n = 158) 2 (n = 98) ≥3 (n = 79) Test Statistic P Values All 0 vs 1 0 vs 2 0 vs ≥3 1 vs 2 1 vs ≥3 2 vs ≥3 No. (%) Clinical setting 23.8a <.001 <.001b .004b .002b .58 .09 .70 Primary 140 (42.7) 99 (62.7) 58 (59.2) 49 (62.0) Psychiatric 188 (57.3) 59 (37.3) 40 (40.8) 30 (38.0) Current MDD chronicc 160 (49.1) 85 (53.8) 65 (66.3) 57 (72.2) 19.2a .001 .33 .003b <.001b .048 .007b .41 Sex 6.5a .09 – – – – – – Male 96 (29.3) 47 (29.7) 35 (35.7) 34 (43.0) Female 232 (70.7) 111 (70.3) 63 (64.3) 45 (57.0) Race 17.0d .009 .04 .08 .001b .99 .34 .45 White 229 (72.7) 99 (63.9) 58 (63.0) 44 (55.7) Black 64 (20.3) 48 (31.0) 29 (31.5) 32 (40.5) Other 22 (7.0) 8 (5.2) 5 (5.4) 3 (3.8) Hispanic ethnicity 52 (15.9) 24 (15.2) 18 (18.4) 7 (8.9) 3.3a .34 – – – – – – Employed 179 (54.6) 88 (55.7) 45 (45.9) 19 (24.1) 26.7a <.001 .82 .13 <.001b .13 <.001b .003b Mean (SD) Age, y 37.5 (12.6) 44.7 (11.7) 48.8 (10.6) 52.8 (9.3) 51.7e <.001 <.001b <.001b <.001b .001b <.001b .01 Education, y 14.1 (3.0) 13.8 (3.0) 13.3 (2.8) 12.7 (2.8) 5.9f <.001 .25 .02 <.001b .23 .006b .12 MDD features Number of prior antidepressants 1.5 (1.6) 1.5 (1.8) 1.8 (2.1) 1.8 (1.6) 5.1a .17 – – – – – – Duration of current episode, mo 51.1 (91.6) 58.0 (94.2) 86.4 (135.0) 83.3 (126.0) 20.6a <.001 .23 .002b .001b .055 .008b .47 Number of prior episodes 9.8 (21.3) 9.2 (19.1) 8.7 (21.7) 5.9 (12.5) 4.8a .19 – – – – – – Age at first episode, y 20.0 (11.9) 25.9 (14.1) 28.0 (14.5) 31.5 (16.5) 51.1a <.001 <.001b <.001b <.001b .25 .02 .17 Test scores WSAS score 27.0 (8.6) 25.4 (9.0) 27.2 (9.3) 29.2 (8.7) 10.9a .01 .09 .69 .02 .09 .001b .14 SCQ score 1.0 (1.3) 3.2 (1.2) 5.8 (1.5) 10.6 (3.1) 493.7a <.001 <.001b <.001b <.001b <.001b <.001b <.001b QIDS-SR16 score 15.7 (4.3) 15.1 (4.2) 15.3 (4.6) 15.5 (3.9) 0.7g .55 – – – – – – -
MDD = major depressive disorder; QIDS-SR16 = 16-item Quick Inventory of Depressive Symptomatology–Self-Report; SCQ = Self-administered Comorbidity Questionnaire; WSAS = Work and Social Adjustment Scale.
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Notes: WSAS scores range from 0 to 40, with higher scores indicating greater levels of impairment. SCQ scores range from 0 to 45, with higher scores indicating greater number of disorders and greater levels of impairment. QIDS scores range from 0 to 27, with higher scores indicating greater levels of depression.
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↵a χ23. The χ2 for continuous measures indicates Kruskal-Wallis test.
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↵b The post hoc comparisons were significant after Bonferroni correction (P <.0083).
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↵c Current episode of MDD ongoing for at least 2 years.
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↵d χ26.
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↵e F3,659.
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↵f F3,636
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↵g F3,640.
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No. of General Medical Conditions Unadjusted Adjusteda Measure 0 (n = 328) 1 (n = 158) 2 (n = 98) ≥3 (n = 79) 0 vs 1 0 vs 2 0 vs ≥3 P Value 0 vs 1 0 vs 2 0 vs ≥3 P Value No. (%) Odds Ratio Odds Ratio Week 12 Exited acute phase 90 (27.4) 47 (29.7) 25 (25.5) 19 (24.1) 1.12 1.01 0.85 .88 1.31 1.12 0.94 .69 Remissionb 135 (41.2) 60 (38.0) 37 (37.8) 24 (30.4) 0.90 0.95 0.58 .29 0.89 0.98 0.67 .62 Last QIDS-SR16 <6 129 (39.6) 55 (34.8) 35 (36.5) 23 (29.1) 0.84 1.08 0.68 .44 0.86 1.15 0.82 .72 Responsec 172 (54.8) 77 (50.0) 51 (54.3) 34 (43.0) 0.80 1.03 0.64 .28 0.89 1.28 0.81 .55 Last WSASd – – – – 1.26 1.40 2.35 .005 1.34 1.40 2.17e .04 Maximum FIBSER Frequency – – – – 1.05 1.04 0.81 .79 1.29 1.21 1.09 .65 Maximum FIBSER Intensity – – – – 1.04 0.84 0.70 .43 1.34 0.93 0.97 .44 Maximum FIBSER Burden – – – – 1.12 0.83 0.89 .69 1.25 0.83 0.95 .49 At least 1 SAE 12 (3.7) 7 (4.4) 5 (5.1) 3 (3.8) 0.61 1.45 0.36 .53 0.53 1.29 0.22 .39 Week 28 Exited continuation phase 123 (37.5) 60 (38.0) 37 (37.8) 23 (29.1) 0.92 0.99 0.68 .58 1.11 1.18 0.74 .58 Remissionb 160 (48.8) 69 (43.7) 38 (38.8) 31 (39.2) 0.87 0.71 0.67 .35 0.78 0.72 0.76 .58 Last QIDS-SR16 <6 156 (48.4) 69 (43.7) 35 (36.1) 32 (40.5) 0.82 0.69 0.70 .35 0.78 0.71 0.80 .57 Responsec 188 (60.6) 93 (60.4) 51 (53.7) 42 (53.2) 0.92 0.89 0.70 .62 0.90 1.01 0.78 .84 Last WSASd – – – – 1.15 1.31 1.70 .14 1.20 1.30 1.49 .48 Maximum FIBSER Frequency – – – – 1.06 1.09 0.86 .85 1.39 1.36 1.27 .40 Maximum FIBSER Intensity – – – – 1.02 0.89 0.80 .77 1.31 0.99 1.11 .61 Maximum FIBSER Burden – – – – 1.13 0.87 1.09 .79 1.25 0.86 1.17 .54 At least 1 SAE 20 (6.1) 9 (5.7) 11 (11.2) 6 (7.6) 0.56 1.88 0.80 .17 0.76 2.32 0.98 .25 Mean (SD) β Coefficient β Coefficient Week 12 Last QIDS-SR16 7.8 (5.3) 8.1 (5.3) 8.5 (6.1) 9.1 (5.0) 0.425 0.390 1.230 .37 0.477 0.190 0.835 .71 % QIDS-SR16 change −48 (34.8) −47 (30.2) −44 (36.7) −39 (35.4) 1.561 3.967 9.238 .21 −0.012 −0.626 3.505 .88 Last SAFTEE-SI N worse 5.1 (5.3) 4.7 (4.5) 5.7 (5.1) 5.7 (5.3) −0.017 0.017 0.179 .28 0.034 0.154 0.237 .34 Week 28 Last QIDS-SR16 7.3 (5.5) 7.3 (5.3) 8.4 (6.2) 8.3 (5.4) 1.043 1.103 1.234 .31 1.085 1.107 1.179 .58 % QIDS-SR16 change −52 (35.4) −52 (30.6) −45 (37.0) −44 (38.8) −0.595 5.387 8.716 .17 −0.315 2.779 4.552 .77 Maximum SAFTEE-SI N worse 9.9 (6.9) 9.6 (5.8) 10.6 (7.0) 11.3 (6.6) 1.037 1.085 1.183 .32 1.011 1.066 1.104 .81 Last SAFTEE-SI N worse 4.7 (5.3) 4.5 (4.7) 6.0 (5.7) 5.4 (5.6) 0.035 0.329 0.211 .07 0.056 0.246 0.129 .40 -
FIBSER = Frequency, Intensity and Burden of Side Effects Rating; QIDS-SR16 = 16-item Quick Inventory of Depressive Symptomatology–Self-Report; SAE = serious adverse event; SAFTEE-SI = Systematic Assessment for Treatment Emergent Events–Systematic Inquiry; WSAS = Work and Social Adjustment Scale.
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Notes: WSAS scores range from 0 to 40, with higher scores indicating greater levels of impairment. SCQ scores range from 0 to 45, with higher scores indicating greater number of disorders and greater levels of impairment. QIDS-SR16 scores range from 0 to 27, with higher scores indicating greater levels of depression. FIBSER scores range from 0 to 6 for each of the indexes.
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↵a Adjusted for treatment, age, education, employment, age at first episode, body mass index, and systolic blood pressure (see Supplemental Table 1, available at http://www.annfammed.org/content/10/1/23/suppl/DC1).
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↵b Patients were classified as being in remission if their last 2 QIDS-SR16 scores were less than 6.
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↵c Patients were classified as having a response if they had a decrease in QIDS-SR16 score of at least 50% from baseline.
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↵d An extremely nonnormal distribution required binning.
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↵e Significant after Bonferroni correction (P <.0083).
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0 General Medical Conditions 1 General Medical Condition 2 General Medical Conditions ≥3 General Medical Conditions BUP+ESC (n = 115) ESC+PBO (n = 112) VEN+MIRT (n = 101) BUP+ESC (n = 50) ESC+PBO (n = 56) VEN+MIRT (n = 52) BUP+ESC (n = 38) ESC+PBO (n = 23) VEN+MIRT (n = 37) BUP+ESC (n = 18) ESC+PBO (n = 31) VEN+MIRT (n = 30) Measure No. (%) No. (%) No. (%) No. (%) P Valuea Week 12 Early termination 37 (32.2) 28 (25.0) 25 (24.8) 14 (28.0) 15 (26.8) 18 (34.6) 11 (28.9) 6 (26.1) 8 (21.6) 8 (44.8) 5 (16.1) 6 (20.0) .53 Remissionb 44 (38.6) 45 (40.2) 40 (40.0) 19 (38.0) 21 (37.5) 15 (28.8) 15 (40.5) 6 (26.1) 14 (38.9) 4 (22.2) 9 (29.0) 10 (33.3) .77 Responsec 55 (50.0) 60 (56.6) 57 (58.2) 29 (58.0) 30 (53.6) 18 (37.5) 21 (56.8) 11 (47.8) 19 (55.9) 6 (33.3) 12 (38.7) 16 (53.3) .19 Last FIBSER Burden .71 No impairment 59 (54.1) 58 (54.7) 46 (47.4) 29 (59.2) 25 (47.2) 26 (53.1) 21 (60.0) 14 (63.6) 16 (47.1) 9 (56.3) 20 (71.4) 21 (72.4) – Minimal/mild 38 (34.9) 41 (38.7) 38 (39.2) 16 (32.7) 24 (45.3) 12 (24.5) 10 (28.6) 3 (13.6) 16 (47.1) 5 (31.3) 6 (21.4) 6 (20.7) – Moderate/marked 8 (7.3) 5 (4.7) 12 (12.4) 3 (6.1) 3 (5.7) 9 (18.4) 3 (8.6) 4 (18.2) 1 (2.9) – 2 (7.1) 1 (3.4) – Severe/intolerable 4 (3.7) 2 (1.9) 1 (1.0) 1 (2.0) 1 (1.9) 2 (4.1) 1 (2.9) 1 (4.5) 1 (2.9) 2 (12.5) – 1 (3.4) – Week 28 Early termination 45 (39.1) 42 (37.5) 36 (35.6) 17 (34.0) 19 (33.9) 24 (46.2) 14 (36.8) 9 (39.1) 14 (37.8) 8 (44.4) 7 (22.6) 8 (26.7) .58 Remissionb 56 (50.0) 58 (52.3) 42 (42.4) 23 (46.0) 25 (44.6) 21 (40.4) 15 (39.5) 8 (34.8) 12 (33.3) 7 (38.9) 10 (32.3) 15 (50.0) .69 Responsec 64 (59.3) 66 (62.9) 58 (59.8) 33 (66.0) 35 (62.5) 25 (52.1) 20 (52.6) 13 (56.5) 18 (52.9) 8 (44.4) 15 (48.4) 19 (63.3) .63 Last FIBSER Burden .96 No impairment 68 (61.8) 66 (62.3) 49 (50.5) 30 (61.2) 34 (64.2) 27 (55.1) 20 (57.1) 14 (60.9) 17 (50.0) 10 (62.5) 21 (75.0) 18 (62.1) – Minimal/mild 30 (27.3) 31 (29.2) 33 (34.0) 16 (32.7) 15 (28.3) 11 (22.4) 11 (31.4) 6 (26.1) 13 (38.2) 3 (18.8) 7 (25.0) 7 (24.1) – Moderate/marked 8 (7.3) 7 (6.6) 14 (14.4) 3 (6.1) 3 (5.7) 10 (20.4) 3 (8.6) 2 (8.7) 4 (11.8) 1 (6.3) – 3 (10.3) – Severe/intolerable 4 (3.6) 2 (1.9) 1 (1.0) – 1 (1.9) 1 (2.0) 1 (2.9) 1 (4.3) – 2 (12.5) – 1 (3.4) – Mean (SD) Mean (SD) Mean (SD) Mean (SD) Week 12 Last QIDS-SR16 7.7 (4.9) 7.7 (5.4) 8.0 (5.7) 8.0 (5.2) 7.1 (4.7) 9.4 (5.8) 8.5 (6.7) 9.1 (5.5) 8.2 (6.0) 9.8 (5.1) 9.4 (4.9) 8.4 (5.3) .44 % QIDS-SR16 reduction −45 (35.4) −49 (35.9) −50 (33.0) −47 (31.8) −52 (28.0) −41 (30.7) −47 (33.6) −42 (25.1) −42 (46.1) −33 (40.0) −37 (33.3) −45 (34.9) .48 Week 28 Last QIDS-SR16 6.7 (4.8) 7.0 (5.6) 8.2 (6.1) 7.1 (5.5) 6.5 (4.3) 8.4 (5.8) 8.4 (6.7) 8.2 (6.1) 8.5 (5.9) 9.3 (4.9) 9.0 (5.5) 6.9 (5.4) .18 % QIDS-SR16 reduction −51 (38.1) −54 (34.3) −50 (33.5) −54 (32.3) −56 (27.3) −46 (32.1) −48 (34.8) −48 (30.8) −40 (43.3) −34 (38.9) −40 (35.8) −54 (40.7) .28 -
BUP = bupropion-SR; ESC = escitalopram; FIBSER = Frequency, Intensity, and Burden of Side Effects Rating; MIRT = mirtazapine; PBO = Placebo; QIDS-SR16 = 16-item Quick Inventory of Depressive Symptomatology–Self-Report; VEN = venlafaxine-XR.
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Note: QIDS-SR16 scores range from 0 to 27, with higher scores indicating greater levels of depression.
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↵a P value associated with the number of general medical conditions by treatment interaction term.
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↵b Patients were classified as being in remission if their last 2 QIDS-SR16 scores were less than 6.
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↵c Patients were classified as having a response if they had a decrease in QIDS-SR16 score of at least 50% from baseline.
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Additional Files
Supplemental Appendixes & Table
Supplemental Appendix 1. Frequency and Intensity of Burden of Side Effects Rating (FIBSER); Supplemental Appendix 2. Concise Health Risk Tracking (CHRT) With Clinician-Rated Behavioral Module; Supplemental Appendix 3. 16-Item Quick Inventory of Depressive Symptomatology�Self-Report: QIDS-SR16
Files in this Data Supplement:
- Supplemental data: Appendix - PDF file, 1 page, 188 KB
- Supplemental data: Appendix - PDF file, 3 pages, 229 KB
- Supplemental data: Appendix - PDF file, 3 pages, 188 KB
- Supplemental data: Table - PDF file, 1 page, 188 KB
The Article in Brief
David W. Morris , and colleagues
Background Major depressive disorder is commonly found in patients with a wide range of general medical conditions, and it may have a major impact on patient functioning. This study looks at the effect of antidepressant treatment combinations in depressed patients with single and multiple general medical conditions.
What This Study Found Though past studies have suggested that patients with general medical conditions are less responsive to antidepressant therapy, this study of the effectiveness and side effects of 3 different antidepressant regimens on patients with multiple medical conditions found only minimal differences in treatment response between groups. Analyzing data on 665 depressed patients with none, 1, 2, or 3 or more treated medical conditions, researchers found almost no statistical difference in efficacy and tolerability. Moreover, there were no differences in outcomes between antidepressant monotherapy and antidepressant combination therapies, regardless of the number of medical conditions the patient had.
Implications
- According to the authors, these findings suggest that depressed patients with or without comorbid conditions can receive safe and effective depression treatment without the risk of adverse effects or antidepressant tolerability.
- The authors report no additional benefit for combination antidepressant therapy versus monotherapy with selective serotonin reuptake inhibitors.
