Persistence
of somatic symptoms in treated depressed
patients
The
prevalence of physical symptoms is high in
primary care and recently a relationship between
somatization and depression has been
established. The majority of depressed patients
complain almost exclusively of somatic symptoms.
The ARTIST (a randomized trial investigating
SSRI treatment) study investigated the outcomes
of physical symptoms in depressed patients.
Thirty seven primary care clinics involving 87
physicians participated in this open label,
intention-to-treat trial which enrolled 573
depressed patients randomized to receive one of
the three selective serotonin reuptake
inhibitors, fluoxetine, paroxetine, or
sertraline. Physical symptoms, depression and
various aspects of health-related quality of
life were assessed at baseline and after 1, 3,
6, and 9 months of treatment.
Major depression was diagnosed in 74% of
subjects, dysthymia in 18%, and minor depression
in 8%. At baseline a third to one half of the
subjects reported 13 of the 14 physical symptoms
assessed, principally fatigue, sleep problems,
headaches, stomach pain, and palpitations. When
present, most symptoms were severe in 10% to 20%
of patients. During the first month of
treatment, physical symptoms greatly improved
and then they plateaued with minimal resolution
during the subsequent months. Depression also
showed a rapid improvement over the first month,
but in contrast to the physical symptoms, a
continued gradual improvement followed over the
next 8 months. Main effects of physical symptoms
were on bodily pain, physical functioning, and
general health, whereas the greatest impact of
depression was on mental health, social and work
functioning.
These results confirm the high prevalence of
somatic symptoms that accompany depression and
which, despite treatment, remain unresolved and
have considerable impact on qualilty of life.
Physicians should be aware of the importance of
the physical symptoms and consider a higher dose
of the antidepressant or switch to a different
drug in order to obtain their complete
remission. Greco
T, Eckert G, Kroenke K. The outcome of physical
symptoms with treatment of depression. J Gen
Intern Med 19: 813-818, 2004.