Antidepressants, social adversity and outcome of depression in general practice

Background The role of current social risk factors in moderating the impact of antidepressant medication has not previously been explored Method In a RCT of SSRIs of general practice patients with mild to moderate depression (HDRS 12-19) two social indices of aversive experience were developed on the basis of prior research First. the Life Events and Difficulties Schedule (LEDS) was used twice to document: 1) recent stressful experience priod to baseline, and it) after baseline and before follow Up at 12 weeks both stressful and positive experiences, taking account of fresh start' and 'difficulty-reduction' events. Second. an index of unemployment-entrapment at baseline was developed for the current project The HDRS was used to measure outcome as a conunous score and as a cutpoint representing improvement below score 8 Results Each social index (LEDS and Unemployment-entrapment) was associated with a lower chance of remission at 12 weeks and each was required to model remission along with treatment arm However there was no interaction the degree of increased remission for those randomised to SSRIs plussupportive care compared to that for those wit h Supportive care alone was the same regardless of social context Limitations Dating of remission was not as thorough as in previous work with the LEDS Detailed examination of positive experiences suggested the large majority were not the result of remitting symptoms. but it is impossible to rule this out altogether Conclusions Remission rates among patients in aversive social contexts are consistently much lower irrespective of treatment There is thus a need to evaluate the efficacy of alternative more socially focussed interventions for depressive conditions likely to take a chronic Course in general practice (C) 2009 Elsevier B V All rights reserved