Differentiating residual symptoms of depression from adverse events among patients initiating treatment with an antidepressant

BACKGROUND: In treated patients with major depressive disorder (MDD), residual symptoms are common and challenging to disentangle from pos­sible antidepressant side effects. Our objective was to prospectively differ­entiate between rates of residual symptoms and treatment-emergent side effects.

METHODS: Participants in an episode of MDD were enrolled in a 6-week trial of an antidepressant. Assessments occurred at baseline and after 6 weeks of treatment, using the Quick Inventory of Depressive Symptomatology– Self‐Report (QIDS‐SR) and the Massachusetts General Hospital Cognitive and Physical Functioning Questionnaire (MGH CPFQ). Among treat­ment responders, residual symptoms were those that remained the same or improved. Side effects were defined as newly emergent or worsening symptoms.

RESULTS: Of 403 participants, 284 completed (70.5%) the trial; 93 (32.7%) were treatment responders. Residual symptoms were common and rep­resented a substantially greater burden than side effects at end point. This was true across symptoms of depression broadly, as captured by items with the QIDS-SR and the MGH CPFQ.

CONCLUSIONS: Prospective assessment is crucial to discriminate between residual symptoms and side effects during antidepressant treatment. This study demonstrated that after 6 weeks of active treatment, symptoms are likely to persist despite response to treatment and are much less likely to represent side effects of medication treatment.

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