New data suggests doctors might not be considering depression symptoms that are important to patients, such as pain and anxiety

Doctors and depressed patients judge symptom severity and improvement following pharmacotherapy differently, according to data presented today at the 20th Annual Meeting of the European College of Neuropsychopharmacology (ECNP) in Vienna, Austria. The data suggest physicians might not be considering symptoms that are important in the eyes of patients, such as pain and anxiety.1

The results are based on a post-hoc analysis of a double-blind, placebo-controlled, multi-center European study in adults with major depressive disorder (MDD) and non-specific pain (n=327). This analysis aimed to compare how patients and physicians estimate overall disease severity at baseline and symptom improvement during short-term treatment of major depression, regardless of treatment group.1 Results showed that physicians treating these patients consider only physician-rated depressive symptoms (as assessed by the Montgomery-Asperg-Depressions Scale or MADRS) when assessing how sick the patient is and whether the patient is getting better. Patients, on the other hand also consider pain and anxiety when judging their own improvement.1

“Previous evidence has suggested that treating both the emotional and the physical symptoms of depression provides patients with the best chance of reaching remission,” said Professor Koen Demyttenaere, Department of Psychiatry, University Hospital Gasthuisberg, Leuven, Belgium and lead author of this study. “These qualitative results highlight the need for physicians to also consider a broad spectrum of symptoms including pain and anxiety when treating patients with Major Depressive Disorder and associated pain.”

Study results
The two main findings of this new analysis are:

* Disease Severity: At the beginning of the study, physician assessment of the overall disease severity was significantly predicted by depression severity (using the MADRS evaluation tool) and paranoid ideation (as measured by the Symptom Checklist, or SCL-90-R); pain was not a consideration.1 After eight weeks of treatment, physicians’ assessment of overall disease severity was significantly predicted by decrease in depression severity (MADRS), being female and of younger age. Among physicians, pain again was not predictive of disease severity.1
* Disease Improvement: Among physicians, overall disease improvement at study end, measured by the Clinical Global Impression of Improvement scale (CGI-I), was significantly positively predicted by decrease in MADRS-rated severity; by decrease in distress in interpersonal sensitivity (measured by the SCL-90-R); and negatively predicted by an older age.1 In contrast, patient rated improvement included improvement in pain. Significant predictors of patient-assessed improvement (as measured by the Patient Global Impression of Improvement scale) were a decrease in pain severity (based on average pain, as measured by the Brief Pain Inventory scale or BPI) depression and anxiety according to SCL-90-R subdomains.1

Furthermore, in this study, the similarity of patient rated disease improvement (PGI-I) and physician rated disease improvement (CGI-I) was investigated by descriptive statistics and a prediction model. In 44.7 percent of cases there was a discrepancy in improvement assessments. In cases of discrepancy, the mean improvement was usually judged higher by physicians than patients (36.3 percent versus 8.4 percent) irrespective of treatment. A lower decrease in MADRS assessed depression severity, pain interference in relation with other people and in interpersonal sensitivity significantly predicted a lower discrepancy between patient and physician improvement. A lower decrease in patient rated pain severity (BPI) and depression (SCL-90-R) significantly predicted a higher discrepancy between physician and patient rated improvement, with the physician rating improvement being higher.

These results provide evidence on the relative importance of different symptoms in depression from a patient perspective and the need to focus beyond core depressive symptoms, when treating depressed patients.