Combination therapy improves patients with depression symptoms: Study

New data presented today at the American Psychiatric Association's annual meeting suggests a benefit to combining L-methylfolate, a prescription medical food called Deplin®, with an antidepressant at the start of treatment.  This retrospective analysis showed a significantly greater improvement in depression symptoms in a shorter period of time, when patients with Major Depressive Disorder (MDD) were started on combination therapy.  The retrospective study compared patients taking L-methylfolate with either a selective serotonin reuptake inhibitor (SSRI) or a serotonin norepinephrine reuptake inhibitor (SNRI) versus patients who were only prescribed an SSRI or SNRI.  

"We know from studies that nearly 70% of depressed individuals will not reach remission by taking one antidepressant alone, so clearly a new approach is needed," explained the study's principal investigator, Lawrence D. Ginsberg, M.D. of Red Oak Psychiatry, Houston, Texas.  "Adding L-methylfolate to an antidepressant at the start of treatment has valuable benefits for these patients."

The study demonstrated that:

  • 2.5 times more patients achieved major improvements in their depressive symptoms, functionality and behavior on combination therapy than on antidepressant monotherapy.  
  • Patients on combination therapy experienced 23% more rapid improvement than those taking antidepressant monotherapy>
  • By 60 days, patients on combination therapy had already experienced a significant improvement>
  • Discontinuation rates due to adverse events were significantly lower in the combination group (17.9%) versus the antidepressant monotherapy group (34%)>

The primary outcome measure used in the study was a two point decline in the Clinical Global Impression-Severity (CGI-S) score, a seven point scale developed by the National Institute of Mental Health.  The CGI-S score is a clinician-determined measure that takes into account all available information, including knowledge of the patient's history, psychosocial circumstances, symptoms, behavior, and the impact of the symptoms on the patient's ability to function.  

"We found that starting patients with a combination of L-methylfolate and an antidepressant was a much more time-efficient approach to help patients get better," explained Dr. Ginsberg.  "Even with an aggressive endpoint, looking for a clinically relevant reduction in symptoms, we found that not only did patients on combination therapy experience a significant improvement in symptom severity but they were able to get better faster and with sustained improvement."

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