Objective: Depression is increasingly seen as a triad of psychological, somatic and physical symptoms that all need to be treated to achieve maximal remission. In primary care, physical symptoms, such as pain, are often the main presenting symptoms. A major depressive disorder is not infrequently encountered in daily clinical practice, often presenting with somatic complaints that include various type of pain, and these may be so prominent as to direct the treatment to the evaluation of the somatic complaint to the exclusion of the underlying psychopathology. It has been suggested that the class of serotonin and norepinephrine reuptake inhibitors (SNRI), which includes Venlafaxine, may be useful in relieving not only psychological symptoms but also chronic pain associated with unipolar depression. The present study aimed at testing this hypothesis in a large group of outpatients with depression. Methods: A total of 475 patients completed a 16-week trial with SNRI (Venlafaxine), SSRIs or TCAs (Table I). Baseline and outcome assessment included the Hamilton Depression Rating Scale (HAM-D), the Improvement scale of the Clinical Global Impression (CGI-I), and the Visual Analogue Scale (VAS) for the evaluation of painful somatic symptoms. Patients with past or current organic mental disorders, manic or hypomanic symptoms, psychotic symptoms were excluded from the study. Enrolled patients had a mean age of 46 years, a mean illness duration of 3 years, and a mean previous period of antidepressant treatment of 2 years. Statistical analysis included Pearson coefficient of correlation for calculating bivariate correlations between continuous variables, analysis of variance (ANOVA) or covariance (ANCOVA) for comparing scores of groups of patients treated with different classes of antidepressant drugs, and regression logistic analysis for identifying significant predictors of response and remission. Results: Clinically significant painful symptoms were present in 40% of the patients. Based on several outcome criteria (i.e., decrease in mean HAM-D and VAS scores, level of CGI improvement, and rates of response and remission), Venlafaxine (mean daily dose: 110 mg) (Table II) appeared to be more effective treatment than SSRI or TCA. Indeed, efficacy analysis, based on the criteria of "response" (HAM-D score percentage change: ≥ 50%) and "remission" (HAM-D final score: ≤ 7), showed that, compared with patients treated with either SSRIs or TCAs, a significantly higher percentage of patients treated with SNRI fulfil the criteria of response or remission (Table III). Improvement of depression (as measured by the total HAM-D score) was significantly and positively correlated (r = 0.50, p < 0.0001) with improvement in painful symptoms (as measured by VAS score). In a logistic regression model, improvement in painful symptoms emerged as a significant predictor of both response and remission (Table IV). Conclusions: The dominant efforts toward improving antidepressant medications are guided by cumulative evidence from neurochemical and clinical studies supporting the therapeutic potential of enhancing monoamine function in depression. There is increasing evidence that, in contrast to SSRIs, which are generally ineffective in treating chronic pain, SNRIs are useful in relieving chronic pain associated with, and independent of, depression. The results of this study confirm that dual action antidepressant drugs, such as Venlafaxine, may offer greater efficacy compared with SSRIs and TCAs in treating the physical symptoms as well as depressive symptoms in patients with unipolar depression.
Siracusano, A., & Troisi, A. (2005). II ruolo della Venlafaxina nella terapia della depressione unipolare con manifestazioni di dolore somatico. GIORNALE ITALIANO DI PSICOPATOLOGIA, 11(4), 445-450.
|Tipologia:||Articolo su rivista|
|Citazione:||Siracusano, A., & Troisi, A. (2005). II ruolo della Venlafaxina nella terapia della depressione unipolare con manifestazioni di dolore somatico. GIORNALE ITALIANO DI PSICOPATOLOGIA, 11(4), 445-450.|
|Settore Scientifico Disciplinare:||Settore MED/25 - Psichiatria|
|Revisione (peer review):||Esperti anonimi|
|Stato di pubblicazione:||Pubblicato|
|Data di pubblicazione:||2005|
|Titolo:||II ruolo della Venlafaxina nella terapia della depressione unipolare con manifestazioni di dolore somatico|
|Autori:||Siracusano, A; Troisi, A|
|Appare nelle tipologie:||01 - Articolo su rivista|