Depression and Comorbid Panic and Pain in Primary Care Patients Public Deposited

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  • March 20, 2019
  • DeVeaugh-Geiss, Angela Marie
    • Affiliation: Gillings School of Global Public Health, Department of Epidemiology
  • Depression is a common and debilitating condition. Though the goal of depression treatment is remission, many patients do not achieve this outcome.1 This research focused on exploring how two common comorbid conditions, panic and pain symptoms, affect depression treatment outcomes in a primary care setting using data from an open-label longitudinal, comparative effectiveness study of three selective serotonin reuptake inhibitors.2 While baseline panic symptoms were not associated with depression outcomes (remission or partial response), persistent panic, or panic symptoms that were present at baseline and month 3, were associated with poorer depression outcomes, particularly remission. Although we used a screening question to assess panic symptoms, the probabilistic sensitivity analysis suggests that the results are robust to varying sensitivity and specificity within a large range of plausible values. Baseline pain symptoms were associated with worse depression outcomes, with evidence of an incremental response with increasing pain severity. Furthermore, the improvement of pain in the first month of treatment was associated with better depression response. Though there is no available information on the minimal clinically important difference on the Patient Health Questionnaire-15 pain subscale, we explored two different cut-points and found similar results with each. Furthermore, there was evidence that a more conservative cut-point resulted in a stronger association of pain improvement and depression outcomes, suggesting that even small changes in pain result in improved depression outcomes. Across all analyses (panic and pain), there was evidence of incremental response, with a stronger association in the remission vs. nonresponse comparison and a weaker association in the partial response vs. nonresponse comparison. These findings suggest that comorbid panic (particularly persistent panic) and pain symptoms are associated with worse depression outcomes in the maintenance phase of treatment. Furthermore, improvements in pain are associated with improved depression outcomes. Consequently, improvement in panic and pain symptoms may be important for improved depression outcomes and primary care physicians should be attuned to the presence of these symptoms when making treatment decisions.
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  • In Copyright
  • West, Suzanne L.
  • Open access

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