Abstract
BackgroundUsing data from the GenPod trial this study investigates: (i) if depressed individuals with multiple physical symptoms have a poorer response to antidepressants before and after adjustment for baseline Beck Depression Inventory II (BDI-II); and (ii) if reboxetine is more effective than citalopram in depression with multiple physical symptoms. MethodsLinear regression models were used to estimate differences in mean BDI-II score at 6 and 12 weeks. ResultsBefore adjusting for baseline BDI-II, the difference in mean BDI-II score between no and multiple physical symptoms was 4.5 (95% CI 1.87, 7.14) at 6 weeks, 4.51 (95% CI 1.60, 7.42) at 12 weeks. After adjustment for baseline BDI-II, there was no evidence of a difference in outcome according to physical symptoms with a difference in mean BDI-II of 2.17 (95% CI −0.39, 4.73) at 6 weeks and 2.43 (95% CI −0.46, 5.32) at 12 weeks. There was no evidence that reboxetine was more effective than citalopram in those with multiple physical symptoms at 6 (P=0.18) or 12 weeks (P=0.24). LimitationsDifferential non-adherence between treatment arms has the potential to bias estimates of treatment efficacy. ConclusionMultiple physical symptoms predict response to antidepressants, but not after adjustment for baseline depression severity. Physical symptoms could be a marker of severe depression rather than an independent prognostic factor and depression should be considered in patients with multiple physical symptoms. Treatment with reboxetine conferred no advantage over citalopram in those with physical symptoms, and it is less well tolerated.
Highlights
Physical symptoms, which are distinct from those considered to be symptoms of depression are common in depression (Haug et al, 2004; Bair et al, 2003)
Multiple physical symptoms are associated with poorer response to antidepressants but we found no evidence for this relationship after adjusting for depression severity
This is consistent with earlier theories on predictors of antidepressant response, whereby biological symptoms were used as a marker of depression severity (Delgado, 2004)
Summary
Physical symptoms, which are distinct from those considered to be symptoms of depression (for example sleep and appetite disturbance) are common in depression (Haug et al, 2004; Bair et al, 2003). It has been estimated that 60% of previously undetected depression cases could have been identified if all primary care patients presenting with pain conditions were examined for possible depression (Katon, 1984). Patients in this group are at risk of receiving an inaccurate diagnosis (Kirmayer et al, 1993; Bridges and Goldberg, 1985), are likely to use more healthcare resources (Bair, 2004; Fritzsche et al, 1999; Widmer and Cadoret, 1978) and are at risk of potential iatrogenic harm. Treatment with reboxetine conferred no advantage over citalopram in those with physical symptoms, and it is less well tolerated
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