Are multiple physical symptoms a poor prognostic factor or just a marker of depression severity? Secondary analysis of the GenPod trial

Amy Green*, Andrew Crawford, Katherine S Button, Nicola Wiles, Tim J Peters, David Nutt, Glyn Lewis

*Corresponding author for this work

Research output: Contribution to journalArticle (Academic Journal)peer-review

Abstract

Background: Using 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.

Methods: Linear regression models were used to estimate differences in mean BDI-II score at 6 and 12 weeks.

Results: Before 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 243 (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).

Limitations: Differential non-adherence between treatment arms has the potential to bias estimates of treatment efficacy.

Conclusion: Multiple 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. (C) 2014 Elsevier B.V. All rights reserved.

Original languageEnglish
Pages (from-to)40-46
Number of pages7
JournalJournal of Affective Disorders
Volume163
DOIs
Publication statusPublished - Jul 2014

Bibliographical note

Copyright © 2014 Elsevier B.V. All rights reserved.

Structured keywords

  • Brain and Behaviour
  • Tobacco and Alcohol

Keywords

  • Depression
  • Antidepressants
  • Citalopram
  • Reboxetine
  • Physical symptoms
  • PRIMARY-CARE
  • SOMATIC SYMPTOMS
  • PSYCHIATRIC-DISORDER
  • TREATMENT RESPONSE
  • PREDICTORS
  • ANXIETY
  • PAIN
  • ANTIDEPRESSANTS
  • OUTCOMES
  • SOMATIZATION

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