Improving outcomes in depression: a focus on somatic symptoms.
BACKGROUND
It is hypothesized that somatic symptom alleviation is a significant predictor of overall outcome in depressed primary care patients.


METHODS
Depressed primary care patients (N=205) meeting DSM-IV-TR criteria received open-label antidepressant therapy. The primary symptom measurement tool used was the 17-item Hamilton Depression Rating Scale (HAMD-17), with the Montgomery-Asberg Depression Rating Scale (MADRS) and the Clinical Global Impression Improvement/Severity (CGI-I/S) used as secondary measures. As proxies for somatic symptoms, 8 items from the HAMD-17 (HAMD-S) and 3 items from the MADRS (MADRS-S) that measure somatic symptoms were identified and extracted.


RESULTS
There was a significant correlation between improvement on the HAMD-S score and overall reduction on the MADRS total score (r=.766, P<.001), response (r=.594, P<.001), and remission (r=.552, P<.001). Improvement on the MADRS-S also correlated with overall HAMD-17 improvement (r=.782, P<.001), along with response (r=.649, P<.001) and remission (r=.539, P<.001) rates. Both the HAMD-S and the MADRS-S correlated with global improvement as measured by the CGI-I/S (P<.001).


CONCLUSIONS
A reciprocal interaction between somatic symptoms and other depressive-symptom domains is implied by this analysis. Clinicians are encouraged to identify, track, and target the somatic symptoms of depressive illnesses.
McIntyre
Roger S
RS
Department of Psychiatry, University of Toronto, Toronto, ON, Canada. roger.mcintyre@uhn.on.ca
Konarski
Jakub Z
JZ
Mancini
Deborah A
DA
Zurowski
Mateusz
M
Giacobbe
Peter
P
Soczynska
Joanna K
JK
Kennedy
Sidney H
SH
D000328:Adult; D000928:Antidepressive Agents / Q000627:therapeutic use; D003865:Major Depressive Disorder / Q000175:diagnosis / Q000523:psychology* / Q000628:therapy*; D039721:Diagnostic and Statistical Manual of Mental Disorders; D005260:Female; D006801:Humans; D008297:Male; D011320:Primary Health Care / Q000379:methods; D012074:Remission Induction; D013001:Somatoform Disorders / Q000175:diagnosis* / Q000523:psychology*
D000928:Antidepressive Agents