Sertraline slightly reduces symptoms of depression and provides other benefits in primary care

Référence

Lewis G, Duffy L, Ades A, et al. The clinical effectiveness of sertraline in primary care and the role of depression severity and duration (PANDA): a pragmatic, double-blind, placebo-controlled randomised trial. Lancet Psychiatry 2019;6(11):903-914.

Sommaire

This extensive real-world study of treating depression in primary care settings enrolled patients with any degree of depressive symptoms rather than targeting a specific level of depression. The study was conducted in 179 primary care offices across the United Kingdom. The authors enrolled 653 adults with depressive symptoms of any severity or duration for whom there was clinical uncertainty about the benefit of antidepressant treatment and who were not receiving antidepressant treatment. Some patients were identified by chart review as having depressive symptoms within the past 2 years and were asked if they wished to have treatment. The Patient Health Questionnaire, 9-item version (PHQ-9) was used to categorize severity, with an average score of 12 out of a possible 27 (moderate depression). The patients were randomized, using concealed allocation, to receive sertraline 50 mg daily for 1 week and then 100 mg, or matching placebo, for up to 11 weeks. Approximately 15% of patients dropped out of the study. Using intention-to-treat analysis, at 6 weeks both groups had lower PHQ-9 scores—8.0 with sertraline vs 8.8 with placebo (the difference not significant). By 12 weeks the average scores were lower with treatment (6.9 vs 8.0) and remission rates (PHQ-9 score 0 - 4) were statistically higher with treatment (45% vs 35%; number needed to treat = 10). Response rates did not vary with degree of initial depression. Anxiety scores were lower and general mental health–related quality of life scores (assessed with the Short Form Health Survey-12) were higher with treatment. Patients in the treatment group were more likely to report they felt an improvement.