Are Two Antidepressants a Good Initial Treatment for Depression?
Major Depression, Dysthymia, Depression NOS
About this trial
This is an interventional treatment trial for Major Depression focused on measuring Major Depression, Dysthymia, Depression NOS, Escitalopram, Bupropion, Dual Therapy, Combination Therapy
Eligibility Criteria
Inclusion Criteria: Currently depressed (DSM-IV Major Depression, Dysthymia or Depression NOS) HAMD-D (21-Item) > 9 Exclusion Criteria: Prior ineffective adequate trial on either study medication ($ 4 weeks on either escitalopram >20 mg/d or bupropion >300 mg/d; >4 weeks on citalopram >40 mg/d) History suggesting increased risk for Seizures (e.g., prior Seizure as an adult, diagnosed Seizure Disorder, taking medication known to increase seizure risk, history of significant head trauma, history of Bulimia or Anorexia) History of intolerance to either study medication unless patient and M.D. agree side effect is probably manageable Alcohol and/or drug abuse/dependence during past year Major medical problems that are not well controlled (e.g., untreated hypertension or diabetes) Bipolar I, Bipolar II History of Psychosis, or current Psychosis Currently taking antidepressants or mood stabilizers, which is judged unwise to discontinue (occasional sleep medication or benzodiazepine for Anxiety is allowed) Not currently depressed (whether considered due to current treatment or not) Active suicidal risk (history of suicide attempts will be evaluated on a case by case basis) Pregnant or breast-feeding Premenopausal women not using known effective birth control
Sites / Locations
- Depression Evaluation Service - New York State Psychiatric Institute
Arms of the Study
Arm 1
Experimental
escitalopram + bupropion
patients begin on escitalopram 10 mg/d, then bupropion 150 mg/d is added and each is alternately increased as tolerated to maximal dose of escitalopram of 40 mg/d and of bupropion of 450 mg/d