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Painful physical symptoms and treatment outcome in major depressive disorder: a STAR*D (Sequenced Treatment Alternatives to Relieve Depression) report

Published online by Cambridge University Press:  03 June 2009

A. F. Leuchter ,
M. M. Husain ,
I. A. Cook ,
M. H. Trivedi ,
S. R. Wisniewski ,
W. S. Gilmer ,
J. F. Luther ,
M. Fava  and
A. J. Rush
A. F. Leuchter*
Affiliation:
Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
M. M. Husain
Affiliation:
Department of Psychiatry, University of Texas Southwestern Medical School, Dallas, TX, USA
I. A. Cook
Affiliation:
Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
M. H. Trivedi
Affiliation:
Department of Psychiatry, University of Texas Southwestern Medical School, Dallas, TX, USA
S. R. Wisniewski
Affiliation:
Department of Epidemiology, University of Pittsburgh Graduate School of Public Health, Pittsburgh, PA, USA
W. S. Gilmer
Affiliation:
Department of Psychiatry and Behavioral Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
J. F. Luther
Affiliation:
Department of Epidemiology, University of Pittsburgh Graduate School of Public Health, Pittsburgh, PA, USA
M. Fava
Affiliation:
Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
A. J. Rush
Affiliation:
Department of Psychiatry, University of Texas Southwestern Medical School, Dallas, TX, USA
*
*Address for correspondence: A. F. Leuchter, M.D., Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA, Laboratory of Brain, Behavior, and Pharmacology, Semel Institute for Neuroscience and Human Behavior at UCLA, 760 Westwood Plaza, Room 37-452, Los Angeles, CA 90024-1759, USA. (Email: [email protected])
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Abstract

Background

Painful physical symptoms (PPS) are both common and reduce the likelihood of remission in major depressive disorder (MDD), based upon results of clinical trials in selected populations. Whether PPS significantly contribute to poorer treatment outcome overall in primary or specialty psychiatric care settings remains unclear.

Method

Out-patients (n=2876) with MDD were treated in the first step of the Sequenced Treatment Alternatives to Relieve Depression (STAR*D) trial with citalopram up to 60 mg/day for up to 14 weeks. Presence of painful symptoms, as well as severity of depression, physical illness, and demographic and treatment factors were examined. Time to and overall rates of remission were analysed in relation to the presence of PPS.

Results

Of the participants, 80% complained of PPS. These patients, both in primary and specialty psychiatric settings, had significantly lower remission rates and took longer to remit. Increasing severity of PPS was associated with greater physical illness burden, lower socio-economic status, absence of private insurance and being female, African-American or Hispanic. After adjustment for these factors, patients with PPS no longer had significantly poorer treatment outcomes.

Conclusions

Presence and severity of PPS is an indicator of MDD that may have poorer treatment outcome with an initial selective serotonin reuptake inhibitor. These poorer treatment outcomes are multifactorial, however, and are not explained by the presence and severity of pain per se.

Keywords

Antidepressant medicationmajor depressionpaintreatment response
Type
Original Articles
Information
Psychological Medicine , Volume 40 , Issue 2 , February 2010 , pp. 239 - 251
Copyright
Copyright © Cambridge University Press 2009

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References

Atkinson, JH, Slater, MA, Capparelli, EV, Wallace, MS, Zisook, S, Abramson, I, Matthews, SC, Garfin, SR (2007). Efficacy of noradrenergic and serotonergic antidepressants in chronic back pain: a preliminary concentration-controlled trial. Journal of Clinical Psychopharmacology 27, 135–142.CrossRefGoogle ScholarPubMed
Axford, J, Heron, C, Ross, F, Victor, CR (2008). Management of knee osteoarthritis in primary care: pain and depression are the major obstacles. Journal of Psychosomatic Research 64, 461–467.CrossRefGoogle ScholarPubMed
Bair, MJ, Robinson, RL, Eckert, GJ, Stang, PE, Croghan, TW, Kroenke, K (2004). Impact of pain on depression treatment response in primary care. Psychosomatic Medicine 66, 17–22.CrossRefGoogle Scholar
Bair, MJ, Robinson, RL, Katon, W, Kroenke, K (2003). Depression and pain comorbidity: a literature review. Archives of Internal Medicine 163, 2433–2445.CrossRefGoogle ScholarPubMed
Fava, M, Alpert, JE, Carmin, CN, Wisniewski, SR, Trivedi, MH, Biggs, MM, Shores-Wilson, K, Morgan, D, Schwartz, T, Balasubramani, GK, Rush, AJ (2004 a). Clinical correlates and symptom patterns of anxious depression among patients with major depressive disorder in STAR*D. Psychological Medicine 34, 1299–1308.CrossRefGoogle Scholar
Fava, M, Mallinckrodt, CH, Detke, MJ, Watkin, JG, Wohlreich, MM (2004 b). The effect of duloxetine on painful physical symptoms in depressed patients: do improvements in these symptoms result in higher remission rates? Journal of Clinical Psychiatry 65, 521–530.CrossRefGoogle ScholarPubMed
Fava, M, Rush, AJ, Alpert, JE, Balasubramani, GK, Wisniewski, SR, Carmin, CN, Biggs, MM, Zisook, S, Leuchter, A, Howland, R, Warden, D, Trivedi, MH (2008). Difference in treatment outcome in outpatients with anxious versus nonanxious depression: a STAR*D report. American Journal of Psychiatry 165, 342–351.CrossRefGoogle Scholar
Fava, M, Rush, AJ, Trivedi, MH, Nierenberg, AA, Thase, ME, Sackeim, HA, Quitkin, FM, Wisniewski, S, Lavori, PW, Rosenbaum, JF, Kupfer, DJ (2003). Background and rationale for the Sequenced Treatment Alternatives to Relieve Depression (STAR*D) study. Psychiatric Clinics of North America 26, 457–494.CrossRefGoogle Scholar
Gameroff, MJ, Olfson, M (2006). Major depressive disorder, somatic pain, and health care costs in an urban primary care practice. Journal of Clinical Psychiatry 67, 1232–1239.CrossRefGoogle Scholar
Garcia-Cebrian, A, Gandhi, P, Demyttenaere, K, Peveler, R (2006). The association of depression and painful physical symptoms – a review of the European literature. European Psychiatry 21, 379–388.CrossRefGoogle ScholarPubMed
Geerlings, SW, Twisk, JW, Beekman, AT, Deeg, DJ, van Tilburg, W (2002). Longitudinal relationship between pain and depression in older adults: sex, age and physical disability. Social Psychiatry and Psychiatric Epidemiology 37, 23–30.CrossRefGoogle ScholarPubMed
Giesecke, T, Gracely, RH, Williams, DA, Geisser, ME, Petzke, FW, Clauw, DJ (2005). The relationship between depression, clinical pain, and experimental pain in a chronic pain cohort. Arthritis and Rheumatism 52, 1577–1584.CrossRefGoogle Scholar
Graff-Guerrero, A, Pellicer, F, Mendoza-Espinosa, Y, Martinez-Medina, P, Romero-Romo, J, de la Fuente-Sandoval, C (2008). Cerebral blood flow changes associated with experimental pain stimulation in patients with major depression. Journal of Affective Disorders 107, 161–168.CrossRefGoogle ScholarPubMed
Greco, T, Eckert, G, Kroenke, K (2004). The outcome of physical symptoms with treatment of depression. Journal of General Internal Medicine 19, 813–818.CrossRefGoogle ScholarPubMed
Hamilton, M (1960). A rating scale for depression. Journal of Neurology, Neurosurgery, and Psychiatry 23, 56–62.CrossRefGoogle ScholarPubMed
Husain, MM, Rush, AJ, Trivedi, MH, McClintock, SM, Wisniewski, SR, Davis, L, Luther, JF, Zisook, S, Fava, M (2007). Pain in depression: STAR*D study findings. Journal of Psychosomatic Research 63, 113–122.CrossRefGoogle Scholar
Jann, MW, Slade, JH (2007). Antidepressant agents for the treatment of chronic pain and depression. Pharmacotherapy 27, 1571–1587.CrossRefGoogle ScholarPubMed
Karp, JF, Scott, J, Houck, P, Reynolds, CF 3rd, Kupfer, DJ, Frank, E (2005). Pain predicts longer time to remission during treatment of recurrent depression. Journal of Clinical Psychiatry 66, 591–597.CrossRefGoogle ScholarPubMed
Khan, AY, Carrithers, J, Preskorn, SH, Lear, R, Wisniewski, SR, Rush, AJ, Stegman, D, Kelley, C, Kreiner, K, Nierenberg, AA, Fava, M (2006). Clinical and demographic factors associated with DSM-IV melancholic depression. Annals of Clinical Psychiatry 18, 91–98.CrossRefGoogle ScholarPubMed
Krell, HV, Leuchter, AF, Cook, IA, Abrams, M (2005). Evaluation of reboxetine, a noradrenergic antidepressant, for the treatment of fibromyalgia and chronic low back pain. Psychosomatics 46, 379–384.CrossRefGoogle ScholarPubMed
Kroenke, K, Shen, J, Oxman, TE, Williams, JW Jr., Dietrich, AJ (2008). Impact of pain on the outcomes of depression treatment: results from the RESPECT trial. Pain 134, 209–215.CrossRefGoogle ScholarPubMed
Lin, EH, Tang, L, Katon, W, Hegel, MT, Sullivan, MD, Unutzer, J (2006). Arthritis pain and disability: response to collaborative depression care. General Hospital Psychiatry 28, 482–486.CrossRefGoogle ScholarPubMed
Linn, BS, Linn, MW, Gurel, L (1968). Cumulative illness rating scale. Journal of the American Geriatric Society 16, 622–626.CrossRefGoogle ScholarPubMed
Marple, RL, Kroenke, K, Lucey, CR, Wilder, J, Lucas, CA (1997). Concerns and expectations in patients presenting with physical complaints. Frequency, physician perceptions and actions, and 2-week outcome. Archives of Internal Medicine 157, 1482–1488.CrossRefGoogle ScholarPubMed
Mathew, RJ, Weinman, ML, Mirabi, M (1981). Physical symptoms of depression. British Journal of Psychiatry 139, 293–296.CrossRefGoogle ScholarPubMed
Mavandadi, S, Ten Have, TR, Katz, IR, Durai, UN, Krahn, DD, Llorente, MD, Kirchner, JE, Olsen, EJ, Van Stone, WW, Cooley, SL, Oslin, DW (2007). Effect of depression treatment on depressive symptoms in older adulthood: the moderating role of pain. Journal of the American Geriatric Society 55, 202–211.CrossRefGoogle ScholarPubMed
Nierenberg, AA, Trivedi, MH, Ritz, L, Burroughs, D, Greist, J, Sackeim, H, Kornstein, S, Schwartz, T, Stegman, D, Fava, M, Wisniewski, SR (2004). Suicide risk management for the Sequenced Treatment Alternatives to Relieve Depression study: applied NIMH guidelines. Journal of Psychiatric Research 38, 583–589.CrossRefGoogle ScholarPubMed
Novick, JS, Stewart, JW, Wisniewski, SR, Cook, IA, Manev, R, Nierenberg, AA, Rosenbaum, JF, Shores-Wilson, K, Balasubramani, GK, Biggs, MM, Zisook, S, Rush, AJ (2005). Clinical and demographic features of atypical depression in outpatients with major depressive disorder: preliminary findings from STAR*D. Journal of Clinical Psychiatry 66, 1002–1011.CrossRefGoogle Scholar
Ohayon, MM, Schatzberg, AF (2003). Using chronic pain to predict depressive morbidity in the general population. Archives of General Psychiatry 60, 39–47.CrossRefGoogle ScholarPubMed
Parmelee, PA, Katz, IR, Lawton, MP (1991). The relation of pain to depression among institutionalized aged. Journal of Gerontology 46, P15–P21.CrossRefGoogle ScholarPubMed
Rush, AJ, Bernstein, IH, Trivedi, MH, Carmody, TJ, Wisniewski, S, Mundt, JC, Shores-Wilson, K, Biggs, MM, Woo, A, Nierenberg, AA, Fava, M (2006 a). An evaluation of the Quick Inventory of Depressive Symptomatology and the Hamilton Rating Scale for Depression: a Sequenced Treatment Alternatives to Relieve Depression trial report. Biological Psychiatry 59, 493–501.CrossRefGoogle ScholarPubMed
Rush, AJ, Carmody, TJ, Reimitz, PE (2000). The Inventory of Depressive Symptomatology (IDS): clinician (IDS-C) and self-report (IDS-SR) ratings of depressive symptoms. International Journal of Methods in Psychiatric Research 9, 45–59.CrossRefGoogle Scholar
Rush, AJ, Fava, M, Wisniewski, SR, Lavori, PW, Trivedi, MH, Sackeim, HA, Thase, ME, Nierenberg, AA, Quitkin, FM, Kashner, TM, Kupfer, DJ, Rosenbaum, JF, Alpert, J, Stewart, JW, McGrath, PJ, Biggs, MM, Shores-Wilson, K, Lebowitz, BD, Ritz, L, Niederehe, G (2004). Sequenced Treatment Alternatives to Relieve Depression (STAR*D): rationale and design. Controlled Clinical Trials 25, 119–142.CrossRefGoogle Scholar
Rush, AJ, Gullion, CM, Basco, MR, Jarrett, RB, Trivedi, MH (1996). The Inventory of Depressive Symptomatology (IDS): psychometric properties. Psychological Medicine 26, 477–486.CrossRefGoogle ScholarPubMed
Rush, AJ, Trivedi, MH, Ibrahim, HM, Carmody, TJ, Arnow, B, Klein, DN, Markowitz, JC, Ninan, PT, Kornstein, S, Manber, R, Thase, ME, Kocsis, JH, Keller, MB (2003). The 16-Item Quick Inventory of Depressive Symptomatology (QIDS), clinician rating (QIDS-C), and self-report (QIDS-SR): a psychometric evaluation in patients with chronic major depression. Biological Psychiatry 54, 573–583.CrossRefGoogle ScholarPubMed
Rush, AJ, Trivedi, MH, Wisniewski, SR, Stewart, JW, Nierenberg, AA, Thase, ME, Ritz, L, Biggs, MM, Warden, D, Luther, JF, Shores-Wilson, K, Niederehe, G, Fava, M (2006 b). Bupropion-SR, sertraline, or venlafaxine-XR after failure of SSRIs for depression. New England Journal of Medicine 354, 1231–1242.CrossRefGoogle Scholar
Simon, GE, VonKorff, M, Piccinelli, M, Fullerton, C, Ormel, J (1999). An international study of the relation between somatic symptoms and depression. New England Journal of Medicine 341, 1329–1335.CrossRefGoogle Scholar
Sindrup, SH, Otto, M, Finnerup, NB, Jensen, TS (2005). Antidepressants in the treatment of neuropathic pain. Basic and Clinical Pharmacology and Toxicology 96, 399–409.CrossRefGoogle ScholarPubMed
Trivedi, MH, Fava, M, Wisniewski, SR, Thase, ME, Quitkin, F, Warden, D, Ritz, L, Nierenberg, AA, Lebowitz, BD, Biggs, MM, Luther, JF, Shores-Wilson, K, Rush, AJ (2006 a). Medication augmentation after the failure of SSRIs for depression. New England Journal of Medicine 354, 1243–1252.CrossRefGoogle ScholarPubMed
Trivedi, MH, Rush, AJ, Ibrahim, HM, Carmody, TJ, Biggs, MM, Suppes, T, Crismon, ML, Shores-Wilson, K, Toprac, MG, Dennehy, EB, Witte, B, Kashner, TM (2004). The Inventory of Depressive Symptomatology, Clinician Rating (IDS-C) and Self-Report (IDS-SR), and the Quick Inventory of Depressive Symptomatology, Clinician Rating (QIDS-C) and Self-Report (QIDS-SR) in public sector patients with mood disorders: a psychometric evaluation. Psychological Medicine 34, 73–82.CrossRefGoogle ScholarPubMed
Trivedi, MH, Rush, AJ, Wisniewski, SR, Nierenberg, AA, Warden, D, Ritz, L, Norquist, G, Howland, RH, Lebowitz, B, McGrath, PJ, Shores-Wilson, K, Biggs, MM, Balasubramani, GK, Fava, M (2006 b). Evaluation of outcomes with citalopram for depression using measurement-based care in STAR*D: implications for clinical practice. American Journal of Psychiatry 163, 28–40.CrossRefGoogle Scholar
Wisniewski, SR, Rush, AJ, Balasubramani, GK, Trivedi, MH, Nierenberg, AA (2006). Self-rated global measure of the frequency, intensity, and burden of side effects. Journal of Psychiatric Practice 12, 71–79.CrossRefGoogle ScholarPubMed
Zimmerman, M, Mattia, JI (2001 a). A self-report scale to help make psychiatric diagnoses: the Psychiatric Diagnostic Screening Questionnaire. Archives of General Psychiatry 58, 787–794.CrossRefGoogle ScholarPubMed
Zimmerman, M, Mattia, JI (2001 b). The Psychiatric Diagnostic Screening Questionnaire: development, reliability and validity. Comprehensive Psychiatry 42, 175–189.CrossRefGoogle ScholarPubMed