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Sertraline may reduce anxiety more quickly than depressive symptoms

Sertraline led to decreased anxiety symptoms within 6 weeks, but its effect on depressive symptoms took longer to emerge, according to data published in Lancet Psychiatry.

“Some studies have argued that antidepressants are more effective for patients with more severe symptoms but most, although not all, meta-analyses of individual patient data do not support this,” Gemma Lewis, PhD, from the division of psychiatry, University College London, and colleagues wrote. “Systematic reviews on the effectiveness of antidepressants for patients with less severe depression have led to contradictory findings.”

In a placebo-controlled randomized trial, Lewis and colleagues evaluated the clinical effectiveness of sertraline in primary care patients with mild to severe depressive symptoms as well as the role of severity and duration in treatment response. Specifically, they included participants where there was clinical uncertainty about prescribing an antidepressant.

Patients received one capsule of sertraline (50 mg) or placebo each day for 1 week then two capsules each day for up to 11 weeks. Researchers examined patients’ depressive symptoms at week 6 via the Patient Health Questionnaire, 9-item version (PHQ-9) as well as depressive symptoms and remission, generalized anxiety symptoms, mental and physical health-related quality of life, and self-reported mental health improvement at 2, 6 and 12 weeks.

Overall, 266 patients who received sertraline and 284 who received placebo were included in analysis.

Lewis and colleagues reported that sertraline failed to produce a clinically meaningful reduction in depressive symptoms after 6 weeks compared to placebo (adjusted proportional difference = 0.95; 95% CI, 0.85-1.07).

However, the results showed that sertraline decreased anxiety symptoms, improved mental health-related quality of life and enhanced self-reported mental health. At 6 weeks, generalized anxiety symptom scores were 21% lower (adjusted proportional difference = 0.79; 95% CI, 0.7-0.89) in patients who took sertraline than those who took placebo.

At 12 weeks, PHQ-9 scores were 13% lower in the sertraline group than the placebo group (0.87; 95% CI, 0.79-0.97), the data showed. In addition, sertraline led to increased likelihood of depression remission at 12 weeks, but not at 6 weeks.

“In cases where there is uncertainty about prescribing an antidepressant, the presence of anxiety symptoms, such as worry and restlessness, could indicate an increased likelihood of benefit,” Lewis and colleagues wrote.

“Clinicians and patients should be aware of the symptoms that are likely to improve so that they can consider alternative management of depressive symptoms that might not respond,” they continued. “Our findings support the prescription of SSRI antidepressants in a wider group of participants than previously thought, including those with mild to moderate symptoms who do not meet diagnostic criteria for depression or generalized anxiety disorder.” – by Savannah Demko

Disclosure: Lewis reports no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.