The goal of this work was to compare the efficacy of the norepinephrine and dopamine reuptake inhibitor bupropion with the selective serotonin reuptake inhibitors (SSRIs) in the treatment of major depressive disorder with high levels of anxiety (anxious depression). Method: Ten double-blind, randomized studies from 1991 through 2006 were combined (N = 2122). Anxious depression was defined as a 17-item Hamilton Rating Scale for Depression (HAM-D-17) anxiety-somatization factor score ≥ 7. Results: Among patients with anxious depression (N = 1275), response rates were greater following SSRI than bupropion treatment according to the HAM-D-17 (65.4% vs. 59.4%, p = .03) and the Hamilton Rating Scale for Anxiety (61.5% vs. 54.5%, p = .03). There was also a greater reduction in HAM-D-17 mean ± SD scores (-14.1 ± 7.6 vs.-13.2 ± 7.9, p = .03) and a trend toward statistical significance for a greater reduction in HAM-A mean ± SD scores (-10.5 ± 7.4 vs.-9.6 ± 7.6, p = .05) in favor of SSRI treatment among patients with anxious depression. There was no statistically significant difference in efficacy between bupropion and the SSRIs among patients with moderate/ low levels of anxiety. Conclusions: There appears to be a modest advantage for the SSRIs compared to bupropion in the treatment of anxious depression (6% difference in response rates). Using the number-needed-to-treat (NNT) statistic as 1 indicator of clinical significance, nearly 17 patients would need to be treated with an SSRI than with bupropion in order to obtain 1 additional responder. This difference falls well above the limit of NNT = 10, which was suggested by the United Kingdom's National Institute of Clinical Excellence. Nevertheless, the present work is of theoretical interest because it provides preliminary evidence suggesting a central role for serotonin in the regulation of symptoms of negative affect such as anxiety.

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Background: Whether the dose of antidepressants can be reduced following clinical improvement without subsequently increasing the likelihood of depressive relapse has not been established. Thus, the aim of this work was to compare relapse rates among patients with major depressive disorder (MDD) randomized to either continue receiving the full versus a reduced dose of antidepressants following partial or full improvement of symptoms. Methods: Five double-blind, randomized clinical trials involving 1,009 patients with MDD randomized to either continue receiving the full versus a reduced dose of antidepressants following partial or full improvement of symptoms were pooled using a random-effect meta-analysis model. Results: Patients randomized to continue treatment with lower doses of antidepressants were more likely to experience a depressive relapse than patients who continued treatment with the full dose (risk ratio 1.62, 95% confidence interval: 1.52–2.80, p = 0.001). Pooled relapse rates were 25.3 and 15.1% for the two treatment groups. Conclusions: Decreasing the antidepressant dose following partial or full symptom improvement is associated with an increased risk of relapse in MDD.

Background The Veterans Health Administration is rolling out a Whole Health system of care as part of an enhanced focus on proactive, person-centered healthcare. Objective Our program evaluation seeks to characterize what Veterans use Whole Health services, for what diagnoses they are seeking Whole Health services, and to examine “high utilizers” of Whole Health services. Methods Data were collected on 174 Veterans using Whole Health services from December 2018 through March 2020 and consisted of chart review and self-report data. Results Women were more likely than men Veterans to use individual only Whole Health services. High utilizers (the top 30% of the sample in Whole Health services used) were more likely to attend groups than the remainder of the sample. Conclusion Future work should examine the community-building aspects of Whole Health and ways to create group programming tailored to women Veterans.