Comparative effectiveness of dual-action versus single-action antidepressants for the treatment of depression in people living with HIV/AIDS.
Depression is the most common psychiatric comorbidity among people living with HIV/AIDS (PLWHA). Little is known about the comparative effectiveness between different types of antidepressants used to treat depression in this population. We compared the effectiveness of dual-action and single-action antidepressants in PLWHA for achieving remission from depression.



We used data from the Centers for AIDS Research Network of Integrated Clinic Systems to identify 1175 new user dual-action or single-action antidepressant treatment episodes occurring from 2005 to 2014 for PLWHA diagnosed with depression. The primary outcome was remission from depression defined as a Patient Health Questionnaire-9 (PHQ-9) score <5. Mean difference in PHQ-9 depressive symptom severity was a secondary outcome. The main approach was an intent-to-treat (ITT) evaluation complemented with a per protocol (PP) sensitivity analysis. Generalized linear models were fitted to estimate treatment effects.



In ITT analysis, 32% of the episodes ended in remission for both dual-action and single-action antidepressants. The odds ratio (OR) of remission was 1.02 (95%CI=0.63,1.67). In PP analysis, 40% of dual-action episodes ended in remission compared to 32% in single-action episodes. Dual-action episodes had 1.33 times the odds of remission (95%CI=0.55,3.21), however the result was not statistically significant. Non-significant differences were also observed for depressive symptom severity.



Missing data was common but was addressed with inverse probability weights.



Results suggest that single-action and dual-action antidepressants are equally effective in PLWHA. Remission was uncommon highlighting the need to identify health service delivery strategies that aid HIV providers in achieving full remission of their patients' depression.
University of North Carolina, Chapel Hill, Department of Epidemiology, United States. Electronic address: jon_mills@med.ufl.edu.
Jon C
JC
Mills
Florida State University, Department of Behavioral Sciences and Social Medicine, United States. Electronic address: jeffrey.harman@med.fsu.edu.
Jeffrey S
JS
Harman
University of Florida, Department of Epidemiology and Medicine, United States. Electronic address: cookrl@ufl.edu.
Robert L
RL
Cook
University of Florida, Department of Health Services Research, Management and Policy, United States. Electronic address: marlownm@phhp.ufl.edu.
Nicole M
NM
Marlow
Indiana University, Indianapolis, Department of Health Policy and Management, United States. Electronic address: charle@iu.edu.
Christopher A
CA
Harle
University of Florida, Department of Health Services Research, Management and Policy, United States. Electronic address: pduncan@ufl.edu.
R Paul
RP
Duncan
University of North Carolina, Chapel Hill, Department of Epidemiology, United States. Electronic address: abengtso@live.unc.edu.
Angela M
AM
Bengtson
University of North Carolina, Chapel Hill, Department of Epidemiology, United States. Electronic address: bpence@unc.edu.
Brian W
BW
Pence
D000328:Adult; D018687:Antidepressive Agents, Second-Generation / Q000627:therapeutic use*; D057186:Comparative Effectiveness Research; D016208:Databases, Factual; D003866:Depressive Disorder / Q000188:drug therapy* / Q000209:etiology; D005260:Female; D015658:HIV Infections / Q000523:psychology*; D006801:Humans; D008297:Male; D012074:Remission Induction; D000068760:Serotonin and Noradrenaline Reuptake Inhibitors / Q000627:therapeutic use*
D018687:Antidepressive Agents, Second-Generation; D000068760:Serotonin and Noradrenaline Reuptake Inhibitors
Antidepressants; Comparative effectiveness; Depression; HIV/AIDS; Inverse probability weights; New user treatment episode