Are multiple physical symptoms a poor prognostic factor or just a marker of depression severity? Secondary analysis of the GenPod trial.
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 2.43 (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).


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


CONCLUSIONS
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.
Centre for Academic Mental Health, School of Social and Community Medicine, University of Bristol, United Kingdom.
Amy
A
Green
Centre for Academic Mental Health, School of Social and Community Medicine, University of Bristol, United Kingdom.
Andrew
A
Crawford
Centre for Academic Mental Health, School of Social and Community Medicine, University of Bristol, United Kingdom.
Katherine S
KS
Button
Centre for Academic Mental Health, School of Social and Community Medicine, University of Bristol, United Kingdom.
Nicola
N
Wiles
School of Clinical Sciences, University of Bristol, United Kingdom.
Tim J
TJ
Peters
Faculty of Medicine, Department of Medicine, Imperial College London, United Kingdom.
David
D
Nutt
Division of Psychaitry, Faculty of Brain Sciences, University College, London, United Kingdom.
Glyn
G
Lewis
D000328:Adult; D000928:Antidepressive Agents / Q000627:therapeutic use*; D015283:Citalopram / Q000627:therapeutic use*; D003863:Depression / Q000175:diagnosis / Q000188:drug therapy*; D005260:Female; D006801:Humans; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D009025:Morpholines / Q000627:therapeutic use*; D011379:Prognosis; D011569:Psychiatric Status Rating Scales; D016032:Randomized Controlled Trials as Topic; D000077593:Reboxetine; D016896:Treatment Outcome
D000928:Antidepressive Agents; D009025:Morpholines; D015283:Citalopram; D000077593:Reboxetine
Antidepressants; Citalopram; Depression; Physical symptoms; Reboxetine