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 journalArticlepeer-review

9 Scopus citations


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
StatePublished - 2009
Externally publishedYes

ASJC Scopus subject areas

  • Clinical Neurology
  • Psychiatry and Mental health


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