Although both paroxetine use and the score on the CIRS-G affected risk – main or direct effect, P=0.004 – paroxetine was more effective in preventing recurrence in patients

with fewer and less severe concomitant medical illnesses – interaction effect, P=0.03. A direct comparison of the sellectchem results of the above studies is difficult, because of the differences among studies. However, most, studies reported lower treatment response in patients who had depression and comorbid Inhibitors,research,lifescience,medical medical illness. Of those studies reporting no difference in treatment outcome in patients with and without medical comorbidity, two studies included only patients who had treatment-resistant depression and had small numbers, Inhibitors,research,lifescience,medical thus having small power to detect, a difference. In conclusion, most studies suggest that depressed medically ill individuals may be more treatment-refractory and may respond slower or less well to antidepressant treatment and have higher rates of depressive relapse in the maintenance phase.54 Conclusion Inhibitors,research,lifescience,medical In depressed patients, psychiatric and medical comorbidity is the rule rather than exception. About 60% to 70%

of depressed patients have at least one comorbid psychiatric condition, about. 30% to 40% have two or more comorbid psychiatric disorders. Furthermore, two thirds of depressed patients have at least one concurrent general medical condition. Among depressed patients, those with a current, comorbid psychiatric condition (in particular an anxiety or substance use disorder) or medical illness seem to have an impaired response and remission Inhibitors,research,lifescience,medical rate during treatment compared

with those patients without comorbidity. However, in depressed patients who all have the same comorbid condition, the relative benefit of an antidepressant compared with placebo seems Inhibitors,research,lifescience,medical to be equal to those effects achieved in depressed patients without comorbidity. These findings raise important, research and treatment issues. Currently, several studies have demonstrated that 65% to 90% of treatment-seeking depressed patients would be excluded from a randomized controlled efficacy trial.55-58 A comorbid psychiatric or medical condition was among the most prominent reasons AV-951 for excluding patients while at the same time present, in the vast majority of depressed patients in clinical practice. Therefore, efficacy trial findings may not generalize to actual practice. A recent editorial summarizing the STAR*D results12 suggested that more broadly representative patients should be enrolled in efficacy trials while ensuring patient safety and internal validity, ‘this would result in a better generalizability of the results achieved in efficacy trials, and could also reduce placebo response rates in these trials that, have risen during the past years.