Effects of race and ethnicity on depression treatment outcomes: The CO-MED trial

Ira M. Lesser, Ahsan Khan, Sidney Zisook, Patrick McGrath, Bradley N. Gaynes, Diane Warden, Stephen R. Wisniewski, A. John Rush, James F. Luther, Madhukar Trivedi, Maurizio Fava

Research output: Contribution to journalArticle

17 Citations (Scopus)

Abstract

Objective: The investigators examined whether outcomes differ by race-ethnicity for patients with major depressive disorder in acute- (12 weeks) and continuation-phase (weeks 12-28) treatment with one of two antidepressant combinations or one selective serotonin reuptake inhibitor. Methods: This single-blind, seven-month prospective, randomized trial enrolled 352 non-Hispanic white (59%), 169 black (28%), and 79 white Hispanic (13%) participants from six primary and nine psychiatric care U.S. sites. Patients had nonpsychotic chronic or recurrent major depressive disorder (or both) of at least moderate severity. Escitalopram plus placebo, bupropion sustained-release plus escitalopram, or venlafaxine extended-release plus mirtazapine were delivered according to measurementbased care. The primary outcome was remission (last two consecutive 16-item Quick Inventory of Depressive Symptomatology-Self- Report ratings <8 and <6); secondary outcomes included side effects, adverse events, quality of life, function, and attrition. Results: Black participants had greater baseline psychiatric and medical comorbidity. Baseline depression severity did not significantly differ between groups. In both phases more blacks than those in other groups exited the trial early. There were only minor differences in side effects, no significant differences in remission rates, and no significant differences between groups in other outcomes for each treatment. Conclusions: Despite differences in sociodemographic characteristics and comorbidities, when measurement-based care was used, members of different minority groups had similar outcomes when treated with one antidepressant or a combination of two antidepressants. Black participants had the highest attrition rate, an important issue to address in clinical care.

Original languageEnglish (US)
Pages (from-to)1167-1179
Number of pages13
JournalPsychiatric Services
Volume62
Issue number10
DOIs
StatePublished - Oct 2011

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Carbon Monoxide
Antidepressive Agents
Citalopram
Major Depressive Disorder
Depression
Psychiatry
Comorbidity
Single-Blind Method
Bupropion
Minority Groups
Serotonin Uptake Inhibitors
Hispanic Americans
Self Report
Placebos
Quality of Life
Research Personnel
Equipment and Supplies
Therapeutics

ASJC Scopus subject areas

  • Psychiatry and Mental health

Cite this

Lesser, I. M., Khan, A., Zisook, S., McGrath, P., Gaynes, B. N., Warden, D., ... Fava, M. (2011). Effects of race and ethnicity on depression treatment outcomes: The CO-MED trial. Psychiatric Services, 62(10), 1167-1179. https://doi.org/10.1176/appi.ps.62.10.1167

Effects of race and ethnicity on depression treatment outcomes : The CO-MED trial. / Lesser, Ira M.; Khan, Ahsan; Zisook, Sidney; McGrath, Patrick; Gaynes, Bradley N.; Warden, Diane; Wisniewski, Stephen R.; Rush, A. John; Luther, James F.; Trivedi, Madhukar; Fava, Maurizio.

In: Psychiatric Services, Vol. 62, No. 10, 10.2011, p. 1167-1179.

Research output: Contribution to journalArticle

Lesser, IM, Khan, A, Zisook, S, McGrath, P, Gaynes, BN, Warden, D, Wisniewski, SR, Rush, AJ, Luther, JF, Trivedi, M & Fava, M 2011, 'Effects of race and ethnicity on depression treatment outcomes: The CO-MED trial', Psychiatric Services, vol. 62, no. 10, pp. 1167-1179. https://doi.org/10.1176/appi.ps.62.10.1167
Lesser IM, Khan A, Zisook S, McGrath P, Gaynes BN, Warden D et al. Effects of race and ethnicity on depression treatment outcomes: The CO-MED trial. Psychiatric Services. 2011 Oct;62(10):1167-1179. https://doi.org/10.1176/appi.ps.62.10.1167
Lesser, Ira M. ; Khan, Ahsan ; Zisook, Sidney ; McGrath, Patrick ; Gaynes, Bradley N. ; Warden, Diane ; Wisniewski, Stephen R. ; Rush, A. John ; Luther, James F. ; Trivedi, Madhukar ; Fava, Maurizio. / Effects of race and ethnicity on depression treatment outcomes : The CO-MED trial. In: Psychiatric Services. 2011 ; Vol. 62, No. 10. pp. 1167-1179.
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