Kuga A, et al. – This observational study intended to investigate how clinical and demographic patient baseline characteristics affect the effectiveness of duloxetine vs. selective serotonin reuptake inhibitor (SSRI) treatment, in real–world Japanese clinical settings of patients with major depressive disorder (MDD) and associated painful physical symptoms (PPS). The authors proposed that duloxetine was more effective compared to SSRIs in patients with the first episode of MDD, with more severe depression, or more severe PPS for Japanese MDD patients with PPS.

• The authors performed a multicenter, 12-week, prospective, observational study in patients with MDD (Quick Inventory of Depressive Symptomatology ≥16) and at least moderate PPS (Brief Pain Inventory-Short Form [BPI-SF] average pain ≥3).
• In this study, patients received duloxetine or SSRIs (escitalopram, sertraline, paroxetine, or fluvoxamine).
• They made assessments by using BPI-SF average pain, 17-item Hamilton Rating Scale for Depression (HAM-D17), EuroQol 5-dimension questionnaire, Social Adaptation Self-Evaluation Scale, Global Assessment of Functioning, and ability to work.
• Predefined subgroups involved the number of previous episodes of depression (0 vs ≥1), baseline BPI-SF average pain score (≤6 vs >6), baseline HAM-D17 total score (≤18 vs >18), baseline HAM-D17 retardation (≤≤7 vs >7) and anxiety somatic subscale scores (≤6 vs >6), and age (<65 vs ≥65 years).

• The authors assessed treatment effectiveness in 523 patients (duloxetine N=273, SSRIs N=250).
• In patients experiencing their first depressive episode, those with higher baseline PPS levels, and in patients with more severe baseline depression, treatment with duloxetine was superior to SSRIs on most outcome measures.
• This was also the case for older patients.
• SSRI treatment tended to indicate more improvements in depression and quality of life measures vs. duloxetine treatment in patients with less severe depression.