Physical symptoms linger despite antidepressant therapy
September 1, 2004
Psychiatry Matters

Physical symptoms are almost as common as emotional ones in patients suffering from depression, but investigators have found that antidepressant treatment may not be effective for the long-term management of physical symptoms.

"Depression is a risk factor for symptoms of pain," noted lead researcher Kurt Kroenke, from Regenstrief Institute in Indianapolis, Indiana, USA. "The most common reports of pain - such as muscle pain, headaches, leg pain - are two to three times more common in people with depression."

To investigate the impact of antidepressant therapy on such symptoms, Kroenke and co-workers monitored 573 depressed patients from 37 clinics during 9 months of treatment with selective serotonin reuptake inhibitors. The prevalence of physical symptoms was determined before treatment, and again after 1, 3, 6, and 9 months of therapy.

In all, 14 physical symptoms were assessed, with 13 present in at least a third to half of the patients before treatment. Each symptom showed some improvement during the first month. Unlike depression, however, which continued to show gradual improvement over the whole 9 months, the reduction in physical symptoms plateaued, with minimal resolution in the subsequent months.

The results, published in the Journal of General Internal Medicine also showed that physical symptoms had a predominant effect on pain, physical functioning, and overall health perceptions. Depression had the greatest impact on mental, social, and work functioning.

"Physical symptoms may not respond to common antidepressant treatment as much as the emotional symptoms," says Kroenke. "Even though the physical symptoms may be related to or aggravated by the depression, they can linger longer than the emotional symptoms."

Kroenke stresses the importance of monitoring the physical symptoms when assessing patients with depression, and, if they persist, the need for additional medical assessments.

J Gen Intern Med 2004; 19: 813-818