Antidepressants, social adversity and outcome of depression in general practice.
BACKGROUND
The role of current social risk factors in moderating the impact of antidepressant medication has not previously been explored.


METHODS
In a RCT of SSRIs of general practice patients with mild to moderate depression (HDRS 12-19) two social indices of aversive experience were developed on the basis of prior research. First, the Life Events and Difficulties Schedule (LEDS) was used twice to document: i) recent stressful experience prior to baseline, and ii) after baseline and before follow up at 12 weeks both stressful and positive experiences, taking account of 'fresh start' and 'difficulty-reduction' events. Second, an index of unemployment-entrapment at baseline was developed for the current project. The HDRS was used to measure outcome as a continuous score and as a cut-point representing improvement below score 8.


RESULTS
Each social index (LEDS and Unemployment-entrapment) was associated with a lower chance of remission at 12 weeks and each was required to model remission along with treatment arm. However there was no interaction: the degree of increased remission for those randomised to SSRIs plus supportive care compared to that for those with supportive care alone was the same regardless of social context.


CONCLUSIONS
Dating of remission was not as thorough as in previous work with the LEDS. Detailed examination of positive experiences suggested the large majority were not the result of remitting symptoms, but it is impossible to rule this out altogether.


CONCLUSIONS
Remission rates among patients in aversive social contexts are consistently much lower irrespective of treatment. There is thus a need to evaluate the efficacy of alternative more socially focussed interventions for depressive conditions likely to take a chronic course in general practice.
Brown
George W
GW
Institute of Psychiatry, Kings College London, Road, London SE1 7EH, United Kingdom. george.brown@kcl.ac.uk
Harris
Tirril O
TO
Kendrick
Tony
T
Chatwin
Judy
J
Craig
Tom K J
TK
Kelly
Vikki
V
Mander
Helen
H
Ring
Adele
A
Wallace
Vuokko
V
Uher
Rudolf
R
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D018687:Antidepressive Agents, Second-Generation / Q000627:therapeutic use*; D004739:England; D005194:Family Practice; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007398:Interpersonal Relations; D008016:Life Change Events; D008297:Male; D008875:Middle Aged; D010555:Personality Inventory / Q000706:statistics & numerical data; D011594:Psychometrics; D012307:Risk Factors; D017367:Selective Serotonin Reuptake Inhibitors / Q000627:therapeutic use*; D012959:Socioeconomic Factors; D016896:Treatment Outcome; D014478:Unemployment / Q000523:psychology; D055815:Young Adult
D018687:Antidepressive Agents, Second-Generation; D017367:Selective Serotonin Reuptake Inhibitors