Effectiveness of Duloxetine Monotherapy Compared to Combination Therapy with Other Antidepressants in Patients with Major Depressive Disorder: A Short-Term, Retrospective Study

다국어 초록 (Multilingual Abstract)

ObjectiveaaThe purpose of this study was to compare duloxetine monotherapy to combination therapy with other antidepressants in patients with major depressive disorder in a clinical, real world setting.
MethodsaaAn eight-week, retrospective, multi-center study of outpatients with major depressive disorder was undertaken. After screening 415 patients, enrolled in this study from July 2009 to June 2014 were 82 patients from among three centers who had been taking duloxetine with or without other antidepressant and not administered with atypical antipsychotics. We compared the mean changes of the Clinical Global Impression-Severity Scale (CGI-S) as a primary measure and the discontinuation rate as a secondary measure between the duloxetine monotherapy group (n=36, 43.9%) and the combination therapy with other antidepressants group (n=46, 56.1%) at baseline, one, two, four and eight weeks.
ResultsaaThere were no significant differences across the demographic characteristics between two groups. There was, however, a statistically greater improvement on the CGI-S at weeks 2, 4 and 8 in the combination group compared with the monotherapy group. There were no significant differences in discontinuation rate and adverse events between two groups. No serious adverse events were reported in both groups during the study period.
ConclusionaaThis result suggests that the duloxetine combination therapy with other antidepressants could improve effectiveness and have comparable tolerability with the monotherapy in the treatment of outpatients with major depressive disorders in a naturalistic setting. Adequately powered, well-controlled clinical trials are strongly warranted to confirm our findings due to methodological shortcomings.

참고문헌 (Reference)

1 Gartlehner G, "The general and comparative efficacy and safety of duloxetine in major depressive disorder : a systematic review and meta-analysis" 32 : 1159-1173, 2009

2 Busner J, "The clinical global impressions scale : applying a research tool in clinical practice" 4 : 28-37, 2007

3 Hudson JI, "Safety and tolerability of duloxetine in the treatment of major depressive disorder : analysis of pooled data from eight placebo-controlled clinical trials" 20 : 327-341, 2005

4 American Psychiatric Association, "Practice guideline for the treatment of patients with major depressive disorder (revision)" 157 (157): 1-45, 2000

5 Fornaro M, "Duloxetine-bupropion combination for treatment-resistant atypical depression: a double-blind, randomized, placebo-controlled trial" 24 : 1269-1278, 2014

6 Detke MJ, "Duloxetine, 60 mg once daily, for major depressive disorder: a randomized double-blind placebo-controlled trial" 63 : 308-315, 2002

7 Goldstein DJ, "Duloxetine in the treatment of major depressive disorder : a double-blind clinical trial" 63 : 225-231, 2002

8 Goldstein DJ, "Duloxetine in the treatment of depression : a double-blind placebo-controlled comparison with paroxetine" 24 : 389-399, 2004

9 Perahia DG, "Duloxetine in the prevention of relapse of major depressive disorder : double-blind placebo-controlled study" 188 : 346-353, 2006

10 Detke MJ, "Duloxetine in the acute and long-term treatment of major depressive disorder : a placebo-and paroxetine-controlled trial" 14 : 457-470, 2004

11 Nemeroff CB, "Duloxetine for the treatment of major depressive disorder" 36 : 106-132, 2002

12 Detke MJ, "Duloxetine 60 mg once daily dosing versus placebo in the acute treatment of major depression" 36 : 383-390, 2002

13 American Psychiatric Association, "Diagnostic Criteria from DSM-IV-TR" American Psychiatric Association 2000

14 Rush AJ, "Combining medications to enhance depression outcomes(CO-MED) : acute and long-term outcomes of a single-blind randomized study" 168 : 689-701, 2011

15 Rush AJ, "Combining antidepressant medications: a good idea?" 167 : 241-243, 2010

16 Thase ME, "Combined antidepressant strategies are not more effective than vigorous escitalopram monotherapy : results of the CO-MED study" 13 : 434-436, 2011

17 Rocha FL, "Combination of antidepressants in the treatment of major depressive disorder : a systematic review and meta-analysis" 32 : 278-281, 2012

18 Blier P, "Combination of antidepressant medications from treatment initiation for major depressive disorder : a double-blind randomized study" 167 : 281-288, 2010

19 Thase ME, "Antidepressant combinations: widely used, but far from empirically validated" 56 : 317-323, 2011

20 United States. Depression Guideline Panel, "Agency for Health Care Policy and Research. Depression in Primary Care" US Deptartment of Health and Human Services 1993

21 Rush AJ, "Acute and longer-term outcomes in depressed outpatients requiring one or several treatment steps : a STAR*D report" 163 : 1905-1917, 2006