The Combination Question

When facing down depression, doctors can find themselves taking shots in the dark. With dozens of different medications available – and only self-reported, nonspecific symptoms to use in diagnosis – how do they decide which patients should receive which antidepressants? Well, current methods are no better than flipping a coin – or so says Madhukar Trivedi, author of a new study from the University of Texas Southwestern Medical Center (1). To address the problem, Trivedi and his colleagues have introduced a new fingerprick blood test that they believe will change the way antidepressants are prescribed.

The researchers randomly gave depression patients escitalopram either alone or in combination with bupropion – and also measured each participant’s C-reactive protein (CRP), serum amyloid P component, and alpha-2-macroglobulin (2). They discovered that patients with high baseline CRP levels – indicating systemic inflammation – were more likely to achieve remission with combination therapy, whereas those with low CRP levels (<1 mg/L) saw better results from escitalopram alone.

Trivedi believes that the results may extend to a host of antidepressant medications, and hopes to move on to larger studies that will test other drugs and alternative biomarkers. “Both patients and primary care providers are desperately looking for markers that would indicate there is some biology involved in this disease,” says Trivedi, whose research offers a glimmer of hope. Is it possible that a simple fingerprick in the doctor’s office could help guide patients to the most effective solution for their depression in the not-too-distant future? Trivedi aims to make it so. “Otherwise, we are talking about deciding treatments based on question-and-answer sessions with patients – and that is not sufficient.”