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  • Title: Pain has a strong negative impact on the fluoxetine response in hospitalized patients with major depressive disorder.
    Author: Lin CH, Lane HY, Chen CC, Juo SH, Yen CF.
    Journal: Clin J Pain; 2011; 27(9):805-10. PubMed ID: 21677571.
    Abstract:
    OBJECTIVES: Response to an antidepressant is frequently the main goal in treating depression. The purpose of this study was to identify predictor(s) of response to the antidepressant, fluoxetine. METHODS: One hundred thirty-one newly hospitalized patients with major depressive disorder received fluoxetine (20 mg/d) for 6 weeks. Symptom severity was assessed using the 17-item Hamilton Depression Rating Scale at weeks 0, 1, 2, 3, 4, and 6. Response was defined as a reduction of ≥50% of the 17-item Hamilton Depression Rating Scale score. We compared the responders and nonresponders in terms of baseline variables. Pain measures included the Short-Form-36 (SF-36) pain severity score and pain interference score. Univariate logistic regression was used to identify variables associated with fluoxetine response. RESULTS: A total of 66 (58.9%) of the 112 completers were classified as responders after a 6-week treatment. The responders and nonresponders did not differ in baseline variables, except melancholic features (Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition criteria) and pain measures (SF-36). SF-36 pain severity score had the smallest P value (P=0.015). Its odds ratio (0.70) means that each point increase in the score of pain severity is expected to decrease the chance of response by approximately 30%. CONCLUSIONS: These findings from newly hospitalized patients with multiple pain measures support the previous studies, which enrolled mainly outpatients and found that a higher level of pain can have a strong negative impact on the antidepressant response. These data require confirmation and extension to outpatients and other antidepressants.
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