Abstract
Background Most patients with major depressive disorder (MDD) report clinically significant sleep problems. Pre-treatment insomnia has been associated with poorer treatment outcomes in some antidepressant trials, leading to suggestions that combined treatment regimens may be more successful in this subgroup. This study investigated this question using data from the CO-MED trial.
Methods Adult outpatients with chronic and/or recurrent MDD were randomly assigned in 1:1:1 ratio to 28 weeks of single-blind, placebo-controlled antidepressant treatment with (1) escitalopram+placebo, (2) bupropion-sustained-release+escitalopram, or (3) venlafaxine-extended-release+mirtazapine. We compared baseline characteristics, tolerability, and treatment outcomes at 12 and 28 weeks for patients with and without pre-treatment insomnia.
Results Of the 665 evaluable patients, the majority (88.3%) reported significant pre-treatment insomnia. Those with pre-treatment insomnia were more likely to be female (69.3% vs. 57.7%) and African-American (29.1% vs. 11.8%). Those with pre-treatment insomnia symptoms reported higher rates of concurrent anxiety disorders, lower rates of alcohol and substance use disorders, and greater impairment in psychosocial functioning. The two groups did not differ in either tolerability or treatment outcomes among the three antidepressant treatments.
Conclusions Insomnia symptoms, while common in patients with chronic/recurrent MDD were not predictive of response, remission, or tolerability with either single or combined antidepressant medications.
| Original language | English (US) |
|---|---|
| Pages (from-to) | 157-164 |
| Number of pages | 8 |
| Journal | Journal of Affective Disorders |
| Volume | 174 |
| DOIs | |
| State | Published - Mar 15 2015 |
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Keywords
- Antidepressant
- Insomnia
- Major depressive disorder
ASJC Scopus subject areas
- Psychiatry and Mental health
- Clinical Psychology
Cite this
Pre-treatment insomnia as a predictor of single and combination antidepressant outcomes : A CO-MED report. / Sung, Sharon C.; Wisniewski, Stephen R.; Luther, James F.; Trivedi, Madhukar H.; Rush, A. John.
In: Journal of Affective Disorders, Vol. 174, 15.03.2015, p. 157-164.Research output: Contribution to journal › Article
}
TY - JOUR
T1 - Pre-treatment insomnia as a predictor of single and combination antidepressant outcomes
T2 - A CO-MED report
AU - Sung, Sharon C.
AU - Wisniewski, Stephen R.
AU - Luther, James F.
AU - Trivedi, Madhukar H.
AU - Rush, A. John
PY - 2015/3/15
Y1 - 2015/3/15
N2 - Background Most patients with major depressive disorder (MDD) report clinically significant sleep problems. Pre-treatment insomnia has been associated with poorer treatment outcomes in some antidepressant trials, leading to suggestions that combined treatment regimens may be more successful in this subgroup. This study investigated this question using data from the CO-MED trial.Methods Adult outpatients with chronic and/or recurrent MDD were randomly assigned in 1:1:1 ratio to 28 weeks of single-blind, placebo-controlled antidepressant treatment with (1) escitalopram+placebo, (2) bupropion-sustained-release+escitalopram, or (3) venlafaxine-extended-release+mirtazapine. We compared baseline characteristics, tolerability, and treatment outcomes at 12 and 28 weeks for patients with and without pre-treatment insomnia.Results Of the 665 evaluable patients, the majority (88.3%) reported significant pre-treatment insomnia. Those with pre-treatment insomnia were more likely to be female (69.3% vs. 57.7%) and African-American (29.1% vs. 11.8%). Those with pre-treatment insomnia symptoms reported higher rates of concurrent anxiety disorders, lower rates of alcohol and substance use disorders, and greater impairment in psychosocial functioning. The two groups did not differ in either tolerability or treatment outcomes among the three antidepressant treatments.Conclusions Insomnia symptoms, while common in patients with chronic/recurrent MDD were not predictive of response, remission, or tolerability with either single or combined antidepressant medications.
AB - Background Most patients with major depressive disorder (MDD) report clinically significant sleep problems. Pre-treatment insomnia has been associated with poorer treatment outcomes in some antidepressant trials, leading to suggestions that combined treatment regimens may be more successful in this subgroup. This study investigated this question using data from the CO-MED trial.Methods Adult outpatients with chronic and/or recurrent MDD were randomly assigned in 1:1:1 ratio to 28 weeks of single-blind, placebo-controlled antidepressant treatment with (1) escitalopram+placebo, (2) bupropion-sustained-release+escitalopram, or (3) venlafaxine-extended-release+mirtazapine. We compared baseline characteristics, tolerability, and treatment outcomes at 12 and 28 weeks for patients with and without pre-treatment insomnia.Results Of the 665 evaluable patients, the majority (88.3%) reported significant pre-treatment insomnia. Those with pre-treatment insomnia were more likely to be female (69.3% vs. 57.7%) and African-American (29.1% vs. 11.8%). Those with pre-treatment insomnia symptoms reported higher rates of concurrent anxiety disorders, lower rates of alcohol and substance use disorders, and greater impairment in psychosocial functioning. The two groups did not differ in either tolerability or treatment outcomes among the three antidepressant treatments.Conclusions Insomnia symptoms, while common in patients with chronic/recurrent MDD were not predictive of response, remission, or tolerability with either single or combined antidepressant medications.
KW - Antidepressant
KW - Insomnia
KW - Major depressive disorder
UR - http://www.scopus.com/inward/record.url?scp=84918566345&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=84918566345&partnerID=8YFLogxK
U2 - 10.1016/j.jad.2014.11.026
DO - 10.1016/j.jad.2014.11.026
M3 - Article
VL - 174
SP - 157
EP - 164
JO - Journal of Affective Disorders
JF - Journal of Affective Disorders
SN - 0165-0327
ER -