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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 8 of 8. This is the beginning of the thread.
Posted by SLS on December 17, 2009, at 11:43:15
This study corroborates one that I read a few weeks ago. Two drugs are better than one. Under what conditions should doctors begin to treat a drug naive patient with combination drug therapy?
- Scott
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Combination of Antidepressant Medications From Treatment Initiation for Major Depressive Disorder: A Double-Blind Randomized StudyPierre Blier, M.D., Ph.D., Herbert E. Ward, M.D., Philippe Tremblay, M.D., Louise Laberge, M.D., Chantal Hébert, R.N., and Richard Bergeron, M.D., Ph.D.
Objective: Various classes of antidepressant medications generally induce remission of major depressive disorder in only about one-third of patients. In a previous study using mirtazapine or paroxetine alone or in combination from treatment initiation, the rate of patients who remitted within a 6-week period was twice that of patients using either drug alone. In this double-blind study, the authors sought to produce evidence for the superiority of different combinations of antidepressant drugs from treatment initiation. Method: Patients (N=105) meeting DSM-IV criteria for major depressive disorder were randomly assigned to receive, from treatment initiation, either fluoxetine monotherapy (20 mg/day) or mirtazapine (30 mg/day) in combination with fluoxetine (20 mg/day), venlafaxine (225 mg/day titrated in 14 days), or bupropion (150 mg/day) for 6 weeks. The primary outcome measure was the Hamilton Depression Rating Scale (HAM-D) score. Results: The overall dropout rate was 15%, without notable differences among the four groups. Compared with fluoxetine monotherapy, all three combination groups had significantly greater improvements on the HAM-D. Remission rates (defined as a HAM-D score of 7 or less) were 25% for fluoxetine, 52% for mirtazapine plus fluoxetine, 58% for mirtazapine plus venlafaxine, and 46% for mirtazapine plus bupropion. Among patients who had a marked response, double-blind discontinuation of one agent produced a relapse in about 40% of cases. Conclusions: The combination treatments were as well tolerated as fluoxetine monotherapy and more clinically effective. The study results, which add to a growing body of evidence, suggest that use of antidepressant combinations from treatment initiation may double the likelihood of remission compared with use of a single medication.
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Posted by Phillipa on December 17, 2009, at 12:45:23
In reply to Combination Drug Treatment From The Beginning, posted by SLS on December 17, 2009, at 11:43:15
The study is MDD or treatment resistant right? Does this include an antianxiety med or a mood stablizer? What of the people that present as anxiety Gad and get depressed if the anxiety isn't controlled? And what about serotonin syndrome. Combine with one that doesn't hit serotonin? And what about SNRI that combines serotonin with norepenephrine? Lots of room for thinking. How you doing on the withdrawal. Love Phillipa
Posted by Phidippus on December 17, 2009, at 15:15:01
In reply to Combination Drug Treatment From The Beginning, posted by SLS on December 17, 2009, at 11:43:15
>Under what conditions should doctors begin to treat a drug naive patient with combination drug therapy?
When there is evidence of partial response to a first medication, but never from the get go.
Also, a patient should be tried on all drugs in a class before an augmentation strategy is planned.
P
Posted by SLS on December 17, 2009, at 16:21:44
In reply to Re: Combination Drug Treatment From The Beginning » SLS, posted by Phidippus on December 17, 2009, at 15:15:01
> >Under what conditions should doctors begin to treat a drug naive patient with combination drug therapy?
>
> When there is evidence of partial response to a first medication, but never from the get go.
>
> Also, a patient should be tried on all drugs in a class before an augmentation strategy is planned.
>
> P
This is a very interesting topic. As simple an idea as it is to start a patient with a de novo drug treatment using a combination of agents, it doesn't seem to be something that has been suggested very often. I imagine combination treatments will become widespread once tests are available to identify an individual's physiological abnormalities. For now, though, I think treatment algorithms can be improved to suggest when to combine drugs and which ones to combine given a patient's response pattern.
- Scott
Posted by willyeee on December 17, 2009, at 21:15:57
In reply to Combination Drug Treatment From The Beginning, posted by SLS on December 17, 2009, at 11:43:15
Great info,actualy it doesent surprise me at all,i have been stating to friends that you rarly see anyone now a days even on a single med,rather a AD a benzo a mood stablizer so on....joke i seen was guy aske 2nd guy,..."Are you bipolar?" 2nd guy Answers"no" 1st guy replies well once u get on a med you will be.
Posted by manic666 on December 18, 2009, at 5:32:10
In reply to Re: Combination Drug Treatment From The Beginning, posted by willyeee on December 17, 2009, at 21:15:57
hey scott you an your megga combo,s an your still as mad as me.if something is wrong with one of the meds, how do you no witch it is,an then you detox 6 meds, i have some bad times but yyyyyyou jesus, little is a lot, think on. ps what happened to the car photos i mailed you you dont have to be jelouse of my far superior wheels its a hobby of mine an the way i will die, 130mph listening to the ramones.bang/////// lights out.
Posted by SLS on December 18, 2009, at 6:05:25
In reply to Re: Combination Drug Treatment From The Beginning, posted by manic666 on December 18, 2009, at 5:32:10
> what happened to the car photos i mailed you
They now reside in my Psycho-Babble archives. Unbelievable. I smiled.
:-)
- Scott
Posted by manic666 on December 18, 2009, at 13:33:54
In reply to Combination Drug Treatment From The Beginning, posted by SLS on December 17, 2009, at 11:43:15
first off scott im glad you like my wheels, the subaru,developed a head gasket leak an was spraying oil on the manifold, not the way to die, crash yes , fire no,£2,500 to repair ,so i offloaded it on a dealer.still the sting us plenty times. Thought you would frame the the cars an hang them on your wall an dream he he//the subaru.s 18inch wheels were black cool or what, an it sounded like the hounds of hell.NOW these multi meds you take ,you didnt answer, if it goes a bit awol how do you no the med to nuke or increase.an the side effects from multi meds must be bad.you get the hole nine yard,s of pain s.to get on a combo in england you would have to go to 6 different p .docs an get 1 med from each.joking aside how the fr*g do you no what ?an how much to take .
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