Dallas—Chronic disease contributes to depression in millions of Americans. The problem, according to a new study, is that common antidepressants might not provide sufficient relief for those patients.
A new study published in JAMA finds that sertraline, marketed as Zoloft, failed to provide significant benefit for depressed patients with chronic kidney disease. Study authors, led by researchers from the University of Texas Southwestern Medical Center’s O’Donnell Brain Institute, point out that previous research raised questions about antidepressant effectiveness in other chronic conditions, such as asthma and congestive heart failure.
“There is little justification in prescribing an antidepressant that will not work and will only cause side effects,” argued senior author Madhukar Trivedi, MD. “We should go back to the drawing board to understand the brain changes involved in these subtypes of depression.”
Background information in the report notes that nearly half of Americans live with some type of chronic medical condition and that depression is rampant in those patients; more than half of Parkinson’s patients have major depressive disorder (MDD), as do 41% of cancer patients and more than 25% of those diagnosed with diabetes, the study notes.
To gauge effectiveness of the antidepressant in CKD patients, the Chronic Kidney Disease Antidepressant Sertraline Trial (CAST) was conducted. The randomized, double-blind, placebo-controlled trial involved 201 patients with stage 3, 4, or 5 non–dialysis-dependent CKD who were enrolled at three medical centers in the United States.
For participants, the Mini Neuropsychiatric Interview was used to establish MDD. A segment of participants—the first of whom became part of the study in March 2010, with the last clinic visit occurring in November 2016—were randomized to sertraline for 12 weeks at an initial dose of 50 mg/d, which was escalated to a maximum dose of 200 mg/d based on tolerability and response. The remainder received a matching placebo.
Researchers were looking for improvement in depressive symptom severity from baseline to 12 weeks, as determined by the 16-item Quick Inventory of Depression Symptomatology–Clinician Rated (QIDS-C16), with secondary outcomes being better quality of life and the rate of adverse events.
With a score range of 0-27 and a minimal clinically important difference of two points, the mean (SD) baseline QIDS-C16 score was 14.0 in the sertraline group and 14.1 in the placebo group. Results indicate that the QIDS-C16 score changed by ?4.1 in the sertraline group and by ?4.2 in the placebo group, with no significant difference between groups in patient-reported overall health on the Kidney Disease Quality of Life Survey.
As for adverse effects, nausea or vomiting occurred more frequently in the sertraline versus placebo group—22.7% versus 10.4%, respectively—as did diarrhea—13.4% versus 3.1%.
“Among patients with non–dialysis-dependent CKD and MDD, treatment with sertraline compared with placebo for 12 weeks did not significantly improve depressive symptoms,” study authors conclude. “These findings do not support the use of sertraline to treat MDD in patients with non–dialysis-dependent CKD.”
Published November 22, 2017