Short term impact of antidepressants on the cardinal symptoms of depression in OSA patients with comorbid MDD who are APAP-adherent: A retrospective study in a veteran population.

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• This study highlights the importance of continued assessment for depressive symptoms in veterans with OSA even after adequate treatment with automatic positive airway pressure (APAP). • Adding psychotropics to patients with depressive symptoms provides measurable benefit in reducing symptoms of depression, such as anhedonia, hopelessness and poor self-esteem, in patients with sleep apnea and comorbid major depressive disorder who are on APAP therapy. • If successful treatment of OSA does not alleviate the mood disturbance, the next step is to target the mood disorder. However, there are no supporting data for such an approach. Further studies are needed to analyze the connection between OSA and affective disorders, especially in the context of APAP treatment. Background: The purpose of the study is to determine whether the addition of antidepressants provides measurable benefit in diminishing symptoms of depression, such as anhedonia, hopelessness and poor self-esteem, in veterans with obstructive sleep apnea (OSA) and comorbid major depressive disorder (MDD) who are on automatic positive airway pressure (APAP) therapy. Methods: This is a retrospective study, involving veterans with MDD and treated OSA who were followed for 3 months. All veterans were compliant with APAP therapy for at least six months prior to their first mental health clinic appointment. The Clinically Useful Depression Outcome Scale (CUDOS) was administered during the first appointment and each subsequent visit with the respective psychiatrist to monitor mood symptoms. The CUDOS total scores were compared between the first visit, APAP pre- antidepressant period and after 3 months of treatment with an antidepressant. Results: The analysis was based on 47 participants, CUDOS scores decreased significantly from the initial score to month 3 with addition of antidepressants, as assessed using a Wilcoxon signed rank test for the paired observations within each participant ( p < 0.01), The median decrease was 21 points with an interquartile range of 14.5–26. Evaluation of the distribution of CUDOS cardinal symptoms of depression (anhedonia, poor self-esteem, and hopelessness) scores shows that scores for each item were reduced. Limitations: Our early work underscores the need for more definitive studies, these results are not ready for adoption to clinical care. Conclusion: Adding pharmacotherapy to patients with depressive symptoms on APAP has significant clinical benefits.