ABSTRACT
Objective. Painful physical symptoms occur frequently in patients with major depressive disorder (MDD), and although numerous studies report the effect of antidepressants on emotional aspects of depression, few focus on their effect on physical symptoms. This observational study was conducted, in a clinical practice setting, to determine antidepressant treatment decisions and their outcome on the physical and emotional symptoms of MDD. Methods. Patients with a mean score ≥2 for pain-related items on the Somatic Symptom Inventory (SSI) were classified with painful physical symptoms (PPS +) and differentiated from the remaining patients (PPS -). Severity of depression and physical pain were determined using the 17-item Hamilton Depression Rating Scale (HAMD17) and Clinical Global Impressions of Severity Scale (CGI-S), and Visual Analog Scale (VAS), respectively. Results. At baseline, 72.6% of patients were PPS+. Compared to PPS- patients, PPS +patients were, on average, significantly more depressed at baseline (mean difference [95% CI]: HAMD17 4.6 [3.6, 5.5] and CGI-S 0.3 [0.2, 0.4]; all p<0.0001), and remained more depressed and in greater pain at endpoint (HAMD17p=0.0074, CGI-S P =0.0151, and VAS P <0.0001). In addition, fewer PPS+ patients (65.8%) achieved remission (total HAMD17≤7) compared to PPS- patients (74.6%, P =0.0180). Conclusions. Painful physical symptoms are prevalent in MDD patients, highlighting the importance of addressing both the physical and emotional symptoms of depression.
ABSTRACT
Se revisan aspectos psicosociales vinculados a las bases neurobiológicas de la fisiopatología de los Trastornos del Ánimo, en especial el Trastorno Bipolar. Se analiza el rol de la transmisión familiar, el género y la edad en el Trastorno Bipolar. La vulnerabilidad a los Trastornos del Ánimo guarda relación tanto con la genética como con los estresores psicosociales, siendo las alteraciones en las vías de transmisión de señales en las cascadas intracelulares, las responsables de las anormalidades estructurales del Sistema Nervioso Central en los Trastornos del Ánimo, discutiéndose sus implicancias en la terapéutica.
Psychosocial issues are reviewed in accordance to neurobiological basis of Major Affective Disorders physiopathology, in particular in Bipolar Disorder. Familiar heritability, gender and age are related to bipolar onset. The links between stressful experiences and vulnerability for Affective Disorders and the intracellular mechanisms in signal transduction pathways that lead to structural abnormalities related with Affective Disorders are discussed as also the implications in therapeutic approaches.