title: Attributes of response in depressed patients switched to treatment with duloxetine.
abstract: BACKGROUND
  This study was designed to assess clinical and functional outcomes associated with switching to duloxetine treatment in patients with major depressive disorder (MDD) experiencing emotional and painful physical symptoms in their current episode.
  
  
  METHODS
  In this 8-week, multinational, multicentre, single-arm, open-label clinical trial, 242 MDD patients were switched to duloxetine 60 mg/day after selective serotonin reuptake inhibitor (SSRI) or serotonin and norepinephrine reuptake inhibitor (SNRI) treatment. The primary analysis compared mean change from baseline in Brief Pain Inventory-Modified Short Form (BPI-SF) interference score between initial responders [≥ 50% reduction from baseline on the 17-item Hamilton Depression Rating Scale (HAMD(17)) Maier subscale] and initial non-responders after 4 weeks. Initial responders continued with duloxetine 60 mg/day. Initial non-responders received duloxetine 120 mg/day for the remaining 4 weeks. Depression, pain, anxiety and functional outcomes were also compared after 8 weeks.
  
  
  RESULTS
  BPI-SF interference decreased from baseline in initial responders (n = 108) and initial non-responders (n = 85) after 4 weeks of duloxetine treatment, with greater reductions in initial responders [BPI-SF mean difference in reduction: 1.01 (95% CI 0.42-1.61); p < 0.001]. Reductions in pain interference favouring initial responders were also apparent after 8 weeks [0.68 (95% CI: 0.03-1.33); p = 0.042]. Depression, pain, anxiety and function improved over 8 weeks across patient groups.
  
  
  CONCLUSIONS
  Elements of core mood and pain are important residual symptoms following poor treatment response in MDD. Early improvement in these symptoms after switching to duloxetine indicated an increased chance of functional recovery.
authors.affiliation: Lilly Research Laboratories, Eli Lilly Canada, Toronto, ON, Canada. sagmand@lilly.com
authors.forename: D
authors.initials: D
authors.lastname: Sagman
authors.forename: D
authors.initials: D
authors.lastname: McIntosh
authors.forename: M S
authors.initials: MS
authors.lastname: Lee
authors.forename: H
authors.initials: H
authors.lastname: Li
authors.forename: S
authors.initials: S
authors.lastname: Ruschel
authors.forename: N
authors.initials: N
authors.lastname: Hussain
authors.forename: R E
authors.initials: RE
authors.lastname: Granger
authors.forename: A C
authors.initials: AC
authors.lastname: Lee
authors.forename: J
authors.initials: J
authors.lastname: Raskin
mesh_terms: D000328:Adult; D000342:Affective Symptoms / Q000188:drug therapy; D000928:Antidepressive Agents / Q000627:therapeutic use*; D059350:Chronic Pain / Q000517:prevention & control; D003865:Major Depressive Disorder / Q000188:drug therapy*; D000068736:Duloxetine Hydrochloride; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D017367:Selective Serotonin Reuptake Inhibitors / Q000627:therapeutic use*; D013876:Thiophenes / Q000627:therapeutic use*; D016896:Treatment Outcome
chemical_list: D000928:Antidepressive Agents; D000068736:Duloxetine Hydrochloride; D017367:Selective Serotonin Reuptake Inhibitors; D013876:Thiophenes