title: Early vs. conventional switching of antidepressants in patients with MDD and moderate to severe pain: a double-blind randomized study.
abstract: BACKGROUND
  Concomitant painful physical symptoms in depressive patients frequently impair functioning and failure to treat these symptoms may adversely impact treatment outcomes of depression. Early vs. conventional switch of antidepressants were compared in patients with major depressive disorder (MDD) and moderate to severe pain.
  
  
  METHODS
  Pre-specified subgroup analysis of a 16-week, randomized, double-blind clinical study on MDD patients with >30 mm overall pain visual analog scale (VAS). Patients not achieving 30% reduction Hamilton Depression Rating Scale (HAM-D) after 4 weeks escitalopram (10 mg/day) were randomized to duloxetine 60-120 mg/day (early switch) or continued on escitalopram (conventional switch) with non-responders at week 8 switching to duloxetine. Endpoints were time to confirmed response and remission, VAS pain severity, and Sheehan disability scale (SDS). Switch strategies were compared using Kaplan-Meier, logistic regression, and repeated measures analyses.
  
  
  RESULTS
  No differences between early and conventional switching were found in time to confirmed response after randomization (3.9 vs. 4.1 weeks, p=0.511) or remission (6.0 vs. 8.0 weeks, p=0.238). Significantly lower VAS mean pain levels at for overall pain, headache, back pain, shoulder pain, interference with daily activities, and time being awake in pain were found for patients in the early switching group. Time to achieving normal functioning (SDS total score <6) was shorter in the early switching group (p=0.042). Safety results were comparable between switch strategies.
  
  
  CONCLUSIONS
  In MDD patients with moderate to severe painful physical symptoms not improving after 4 weeks of treatment with escitalopram, an earlier switch to duloxetine may lead to better pain and functional outcomes.
authors.affiliation: Medical Department, Eli Lilly and Company, Madrid 28108, Spain. romera_irene@lilly.com
authors.forename: Irene
authors.initials: I
authors.lastname: Romera
authors.forename: Victor
authors.initials: V
authors.lastname: Pérez
authors.forename: Jose Manuel
authors.initials: JM
authors.lastname: Menchón
authors.forename: Alexander
authors.initials: A
authors.lastname: Schacht
authors.forename: Rita
authors.initials: R
authors.lastname: Papen
authors.forename: Doris
authors.initials: D
authors.lastname: Neuhauser
authors.forename: Mocrane
authors.initials: M
authors.lastname: Abbar
authors.forename: Hernan
authors.initials: H
authors.lastname: Picard
authors.forename: Inmaculada
authors.initials: I
authors.lastname: Gilaberte
mesh_terms: D000203:Activities of Daily Living / Q000523:psychology; D000328:Adult; D000368:Aged; D000928:Antidepressive Agents / Q000627:therapeutic use*; D015283:Citalopram / Q000627:therapeutic use*; D003865:Major Depressive Disorder / Q000188:drug therapy* / Q000503:physiopathology; D004311:Double-Blind Method; D057915:Drug Substitution / Q000379:methods*; D000068736:Duloxetine Hydrochloride; D005260:Female; D006801:Humans; D060828:Induction Chemotherapy; D008297:Male; D008875:Middle Aged; D010146:Pain / Q000188:drug therapy* / Q000503:physiopathology; D010147:Pain Measurement; D013876:Thiophenes / Q000627:therapeutic use*; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D000928:Antidepressive Agents; D013876:Thiophenes; D015283:Citalopram; D000068736:Duloxetine Hydrochloride