BOCA RATON, FLA. — Targeting physical symptoms of depression in a primary care setting increases the likelihood of treatment response and remission, according to a multicenter study.
Somatic symptoms of depression are getting increased attention as part of a drive to achieve asymptomatic remission, said Sidney H. Kennedy, M.D. He and his associates hypothesized that alleviation of physical symptoms of depression would improve response and remission rates.
They assessed 205 patients undergoing open-label antidepressant treatment for 8 weeks in 47 primary care settings. Patients were being treated with venlafaxine, citalopram, fluoxetine, paroxetine, sertraline, bupropion, or mirtazapine. Mean patient age was 43 years, and 64% were female. A total of 157 patients completed the study.
At baseline, and every 2 weeks thereafter, researchers compiled an aggregate somatic score for each patient based on eight items culled from the Hamilton Depression Rating Scale (HAMD). This shorter instrument (HAMD-S) assessed gastrointestinal somatic symptoms; weight loss; early, middle, and late insomnia; general somatic symptoms; somatic anxiety; and hypochondriasis.
Two other scales—the Montgomery Asberg Depression Rating Scale (MADRS) and the Clinical Global Impression Scale for Improvement and Severity of Illness—were used to measure depression severity.
Results were presented during a poster session at a meeting of the New Clinical Drug Evaluation Unit sponsored by the National Institute of Mental Health.
HAMD-S scores decreased from a mean of 10 at baseline to 3 at week 8, a statistically significant difference. There was a significant correlation between improvements on the HAMD-S and overall reductions in MADRS total score, response score, and remission score. Both HAMD-S and MADRS findings correlated with Clinical Global Impression Scale findings.
“The bottom line is we showed that physical symptoms responded comparably with the other symptoms,” said Dr. Kennedy, a psychiatrist with the University Health Network, Toronto.
The HAMD-S and MADRS scales, however, have not been validated as somatic subscales, Dr. Kennedy cautioned. This is a possible limitation of the study.
The study was funded by Wyeth Pharmaceuticals. Dr. Kennedy is a consultant and speaker for the company.