Clinical and functional outcomes in patients with major depressive disorder and painful physical symptoms switched to treatment with duloxetine

Wang

Journal of Clinical Psychopharmacology

2015

The aim of the study was to determine whether baseline pain was associated with discernible clinical features and treatment outcomes for patients with major depressive disorder (MDD) receiving 6-week fluoxetine treatment. A total of 131 inpatients with acutely ill MDD were enrolled to receive 20 mg of fluoxetine daily for 6 weeks. Pain was measured by the Short-Form 36 body pain index. Symptom severity, functional impairment, and severity of adverse events were assessed at baseline and again at weeks 1 to 4 and 6 using the 17-item Hamilton Depression Rating Scale, Modified Work and Social Adjustment Scale, and Utvalg for Kliniske Undersogelser Side Effect Rating Scale, respectively. Simple linear regression was employed to examine the clinical variables significantly associated with pain. The generalized estimating equations method was used to analyze the influence of pain on the 17-item Hamilton Depression Rating Scale, Modified Work and Social Adjustment Scale, and Utvalg for Kliniske Undersogelser Side Effect Rating Scale over time. Of the 131 participants, 119 (90.8%) who completed baseline pain measurements and had at least 1 postbaseline assessment were included in the analysis. Patients experiencing greater pain were more likely to have more severe depression, to be at greater risk of suicide, to have functional impairment, to experience stressful life events, and to have poor treatment outcomes. These findings suggest that pain was significantly associated with multiple aspects of patients with MDD. Patients with MDD with higher levels of pain were clinically useful in predicting poor outcomes after acute fluoxetine treatment.

Section: Discussionmentioning

confidence: 99%

Pain Affects Clinical Patterns and Treatment Outcomes for Patients With Major Depressive Disorder Taking Fluoxetine

Wang

Journal of Clinical Psychopharmacology

2015

“…Investigators concluded that continuation of an index AD offers inferior 31 may be used to suggest that patients who do not improve may benefit from a treatment switch that occurs earlier than usual; notwithstanding, other studies have failed to confirm this finding. 32,33 Further, it remains unclear whether the improvement observed resulted from a switch from an SSRI to a serotonin and norepinephrine reuptake inhibitor, or if switching to an alternative medication of the same class (for example, SSRIs) would have yielded similar benefits.…”

Section: What Is the Optimal Trial Duration With Ads?mentioning

confidence: 99%

Predicting Treatment Response in Major Depressive Disorder: The Impact of Early Symptomatic Improvement

2012

Objective: Antidepressants (ADs) are the mainstay of treatment for major depressive disorder (MDD). Despite their widespread usage, a consensus does not exist as to the timing of clinically significant symptomatic improvement during an AD trial. The objective of this review is to provide practitioners with empirically based recommendations pertaining to the optimal duration of index (initial) AD therapy before a clinical intervention is warranted. Methods:We conducted a nonsystematic review, using a combination of a MeSH key word search, Google Scholar, and the Scopus database. Our search strategy focused on research papers reporting on the early symptomatic response to AD therapy.Results: Available evidence suggests that there are several subpopulations that exist within whole-group data assigned to an AD treatment. Among the responder subgroups, an early responder group (that is, less than 3 weeks) and later responder group (that is, 3 weeks or more) are identified. People who exhibit early partial symptomatic improvement are more likely to respond to therapy thereafter. However, the interpretability of extant evidence is complicated by the use of disparate statistical approaches with differing computational complexity and sample heterogeneity. Conclusions:Response outcomes in MDD are heterogeneous. Available data suggest that people may respond early, late, and (or) continuously over time, and may represent distinct subpopulations that provide a proximate indication for treatment response outcomes. Notwithstanding, a pragmatic recommendation would be to consider a treatment intervention (for example, dosage optimization and [or] augmentation) if, after 3 to 4 weeks, symptomatic improvement is insufficient. W W WObjectif : Les antidépresseurs (AD) sont le soutien principal du traitement du trouble dépressif majeur (TDM). Malgré leur usage répandu, il n'y a pas de consensus sur la chronologie de l'amélioration symptomatique cliniquement significative durant un essai d'AD. L'objectif de cette étude est de fournir aux médecins des recommandations éclairées par les preuves empiriques concernant la durée optimale d'un premier traitement (initial) par AD avant qu'une intervention clinique soit justifiée.Méthodes : Nous avons mené une revue non systématique, à l'aide d'une combinaison de recherche par mot clé dans MeSH, Google Scholar, et Scopus Database. Notre stratégie de recherche portait sur les articles de recherche traitant de la réponse symptomatique précoce au traitement par AD.Résultats : Les données probantes disponibles suggèrent qu'il existe plusieurs souspopulations au sein des données de groupes entiers associées à un traitement par AD. Parmi les sous-groupes de répondants, un groupe de répondants précoces (c'est-à-dire, moins de 3 semaines) et un groupe de répondants tardifs (c'est-à-dire, 3 semaines ou plus) sont identifiés. Les personnes qui affichent une amélioration symptomatique partielle précoce sont plus susceptibles de répondre au traitement par la suite. Cependant, l'interprétabilité des donné...

“…6 Functional impairment in patients with MDD seems to improve with treatment along with reduction in depressive symptoms. 7,8 However, functional recovery may lag behind symptomatic remission, [9][10][11] and residual symptoms of depression can delay full functional recovery even in patients who have achieved clinical remission. 12 Treatment goals for patients with MDD, therefore, should include both symptom remission and functional recovery.…”

Section: Introductionmentioning

confidence: 99%

Categorical improvement in functional impairment in depressed patients treated with desvenlafaxine

2017

Objective. This post-hoc pooled analysis evaluated categorical change in functional impairment in patients with major depressive disorder (MDD) treated with desvenlafaxine versus placebo and examined whether early improvement in functioning predicted functional outcomes at study endpoint.Methods. Data were pooled from eight randomized, double-blind, placebo-controlled studies of desvenlafaxine for the treatment of MDD, including adults who were randomly assigned to receive desvenlafaxine 50 or 100 mg/d or placebo (N = 3,384). Shift tables were generated for categorical changes in functional impairment from baseline based on Sheehan Disability Scale (SDS) subscale scores. The categories were none/mild (0-3), moderate (4-6), and marked/ extreme (7-10). Treatment comparisons for prespecified shifts of interest and predictive value of week 2 or 4 improvement in SDS subscale scores for functional outcome at week 8 were assessed using logistic regression.