Symptoms Can Persist Despite Long-Term SSRI Treatment


BARCELONA — Despite long-term treatment with selective serotonin reuptake inhibitors, many depressed patients cared for by primary care physicians continue to experience symptoms that affect their daily lives, according to a survey conducted in the United Kingdom.

Only a minority of these patients were satisfied with their current sleep, while 52% reported moderate-severe anxiety and 37% moderate-severe depression, although most had been on treatment for 6 months to more than 1 year, Dr. Alan G. Wade wrote in a poster presented at the annual congress of the European College of Neuropsychopharmacology.

“If patients are to have a good quality of life with the maximum possibility of remaining free from subsequent episodes of depression, it's important that treatment results in patients who are in remission with a minimal number of symptoms,” wrote Dr. Wade, a founder of Patients Direct in Glasgow, Scotland. “But despite long-term SSRI treatment, few of these patients were in true remission.”

Patients Direct operates in tandem with the Robertson Centre for Biostatistics at the University of Glasgow. The company obtains postmarketing drug data by direct patient survey and supplies this information to health care providers, the pharmaceutical industry, and other interested groups, according to the company Web site. Dr. Wade's analysis was based on surveys completed by 256 patients in western Scotland whose general practitioners were treating them for depression with SSRIs.

Prescribing information was obtained from a large regional database, and each patient filled out a questionnaire about treatment. The survey included the Hospital Anxiety and Depression Scale (HADS), and specific questions about sleep. The group was primarily composed of women (79%). Most of the patients (190) were aged 36–70 years, with the remainder aged 18–35 years. The primary indication for SSRI was depression (80%). Other indications were anxiety and pain.

Length of treatment varied, with 56% having taken the drugs for more than a year; 13% for 7–12 months; 18% for 4–6 months; and 12% for 1–3 months. The rest had been on an SSRI for a month or less. Most (90%) said that they took the medication as directed.

HADS scores showed that depression and anxiety persisted in many patients, despite the medication. Fewer than half (42%) scored “normal” on the scale; 21% reported minor symptoms. Among the participants, 20% reported moderate depression, while 17% reported severe depression.

Symptoms of anxiety did not respond even that well to the medication. Just 20% of patients had normal scores on the HADS anxiety subscale. Mild symptoms occurred in 22%, moderate symptoms in 23%, and severe symptoms in 29%.

About a third of patients complained of poor sleep—32% felt their sleep problems were so severe that others could notice them, and 29% said the sleep issues interfered with their daily life and were a source of significant distress. This finding was significantly associated with higher depression and anxiety scores.

Most patients with sleep problems (62%) never mentioned the issue to their general practitioner, although of those who did, 51% got a prescription for a sleep aid. However, more than half of those who received a hypnotic prescription ended up taking it for longer than the recommended 4-week period.

“The long-term use of hypnotics presents its own problems,” Dr. Wade pointed out, “but there is some evidence that addressing sleep as a symptom of depression can provide benefit.”

He noted that the survey results are similar to findings in a recent paper addressing remission in depression. The review found that many patients treated for depression report residual symptoms despite apparently successful treatment (Psychol. Med. 2007;37:307-17).

Dr. Wade's study was sponsored by an unrestricted educational grant from Servier Laboratories Ltd., a European company that is developing a new antidepressant, agomelatine, for the U.S. market.

Next Article: