Combining Medications to Enhance Depression Outcomes (CO-MED): Acute and
Long-term Outcomes of a Single-Blind Randomized Study
Rush AJ, Trivedi MH, Stewart JW, et al
Am J Psychiatry. 2011;168:689-701
Effectiveness of Switching From Antipsychotic Polypharmacy to Monotherapy
Essock SM, Schooler NR, Stroup TS, et al; The Schizophrenia Trials Network
Am J Psychiatry. 2011;168:702-708
Gabapentin Combined With Naltrexone for the Treatment of Alcohol Dependence
Anton RF, Myrick H, Wright TM, et al
Am J Psychiatry. 2011;168:709-717
Summary of Studies
Három cikket ismertet a MEdscape. Rövid magyar kivonat:
Az első cikk major depresszióban szenvedőknél vizsgálta a monoterápia versus AD
kombináció előnyeit. Nem mutatkozott a kombinált kezelés előnyösebbnek.
A második vizsgálat egy bonyolult modellben vizsgálta az egy, ill. több antipszichotikummal
végzett kezelés hatásait. Itt a monoterápia előnyösebb volt, a betegek együttműködése, a
mellékhatások (pl. testsúly), stb. szempontjából, a többféle kombináció nem volt jobb a
tünetek visszaszorítására. Javasolják, hogy próbáljuk az ilyen betegeket monoterápia felé
mozdítani.
A harmadik vizsgálat alkoholbetegnél előnyösebbnek mutatta a naltrexone-gabapentin
kombinációt a csak naltrexone, ill. csak plac. kezeléshez viszonyítva.
Three articles were published in the July 2011 issue of the American Journal of Psychiatry that
reported on the potential utility of combinations of psychotropic medications, a practice commonly
encountered in real-world clinical settings. In the first study,[1] 2 antidepressant medication
combinations were compared with selective serotonin reuptake inhibitor monotherapy to determine
whether either combination produced a higher remission rate in first-step acute-phase (12 weeks) and
long-term (7 months) treatment. The study enrolled 665 outpatients with at least moderately severe
nonpsychotic chronic and/or recurrent major depressive disorder. Patients were randomized to receive
escitalopram plus placebo, sustained-release bupropion plus escitalopram, or extended-release
venlafaxine plus mirtazapine. Patients, but not study personnel, were blinded to the identity of the
second agent being administered (placebo, escitalopram, or mirtazapine). Remission and response
rates and most secondary outcomes were not different among treatment groups at 12 weeks. The
remission rates were 37.7%-38.9% and the response rates were 51.6%-52.4%. At 7 months,
remission rates (41.8%-46.6%), response rates (57.4%-59.4%), and most secondary outcomes were
not significantly different. The authors concluded that neither medication combination outperformed
monotherapy and that the combination of extended-release venlafaxine plus mirtazapine may have a
greater risk for adverse events.
The second study[2] enrolled 127 adult outpatients with schizophrenia taking 2 antipsychotics who were
then randomly assigned to stay on polypharmacy or switch to monotherapy by discontinuing 1
antipsychotic. Treatment was open-label with blinded clinical raters. The trial lasted 6 months, with a
6-month naturalistic follow-up. Patients assigned to switch to monotherapy had shorter times to allcause treatment discontinuation than those assigned to stay on polypharmacy but the 2 groups did not
differ with respect to psychiatric symptoms or hospitalizations. On average, the monotherapy group
lost weight, whereas the polypharmacy group gained weight. Two thirds of participants were
successfully switched. The suggestion is that it is reasonable to encourage trials of antipsychotic
monotherapy for individuals receiving antipsychotic polypharmacy and that patients should be free to
return to polypharmacy if an adequate trial on antipsychotic monotherapy proves unsatisfactory.
The third study[3] enrolled 150 alcohol-dependent individuals in a double-blinded trial and evaluated
whether the combination of naltrexone and gabapentin was better than naltrexone alone and/or
placebo alone during the early drinking cessation phase (first 6 weeks) and, if so, whether this effect
persisted. During the first 6 weeks, the naltrexone-gabapentin group had a longer interval to heavy
drinking than the naltrexone-alone group, which had an interval similar to that of the placebo group;
had fewer heavy drinking days than the naltrexone-alone group, which in turn had more than the
placebo group; and had fewer drinks per drinking day than the naltrexone-alone group and the
placebo group. However, these differences faded over the remaining weeks of the study after
gabapentin was discontinued. This trial was thus supportive of a combination approach.