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, Sheldon H. Preskorn

Research output: Contribution to journalArticle

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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.

Original languageEnglish (US)
Pages (from-to)487-498
Number of pages12
JournalCNS Spectrums
Issue number9
Publication statusPublished - 2009


ASJC Scopus subject areas

  • Clinical Neurology
  • Psychiatry and Mental health

Cite this

Shelton, R. C., Hollon, S. D., Wisniewski, S. R., Alpert, J. E., Balasubramani, G. K., Friedman, E. S., ... Preskorn, S. H. (2009). Factors associated with concomitant psychotropic drug use in the treatment of major depression: A STAR*D report. CNS Spectrums, 14(9), 487-498.