Abstract
Background: Depression is usually managed in primary care and antidepressants are often the first-line treatment, but only half of those treated respond to a single antidepressant.
Objectives: To compare efficacy of Escitalopram monotherapy versus combination with L-methyl folate or Mirtazapine in first episode of Depression
Design: The comparative follow-up study was conducted from June 2021 to May 2022 in the Department of Psychiatry, MGM medical college, Indore (M.P.).
Setting: Participants were recruited from Psychiatry outpatient department (OPD) in Mental Hospital Indore and MY Hospital, Indore.
Participants: The study included 40 patients of age 18-45 years, attending Psychiatry outpatient department (OPD in Mental Hospital Indore and MY Hospital Indore, fulfilling the inclusion criteria.
Interventions: Participants were divided into three groups- A, B and C. Group A was given Escitalopram as drug monotherapy, and Group B was given Escitalopram with L-methyl folate 7.5mg and group C was given Escitalopram with Mirtazapine 7.5mg combination therapy. Follow up was done on 2nd and 4th to assess improvement in the symptoms.
Results: On comparing HAM scores for R50 (50% reduction in initial HAM score) in each group. In group A, R50 was achieved in 20% patients in the 4th week. In group B, R50 was achieved at 12.5% in the 2nd week, 30% in the 4th week. In group C, R50 was achieved 37.5% in 4th week. The majority of the population in our study belongs to lower socio-economic status and were unemployed resulting in dietary deficiencies hence responded well with L-methyl folate which can cross blood brain barrier.
Conclusions: On the basis of available literature and result of the index study, it can be concluded that combination therapies showed better response suggested by HAM scores at the end of study. Moreover, the response achieved with combination therapies were earlier as compared to monotherapy. This substantiate the findings of previous studies. Thus, the study suggest earlier response rates when patients received L-Methylfolate 7.5mg. When compared with monotherapy both the combination therapies achieved earlier and better response.

Key words: Depression, antidepressants