Sertraline eases anxiety, not depression, at 6 weeks

  • Lewis G & al.
  • Lancet Psychiatry
  • 19 Sep 2019

  • International Clinical Digest
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Takeaway

  • Primary care patients who received sertraline for depression showed no decrease in depressive symptoms vs placebo at 6 weeks, but did report decreased anxiety, better mental health-related QoL, and improvements in mental health.

Why this matters

  • Depression is usually managed in a primary care setting, but most antidepressant trials are conducted in patients receiving secondary mental health services.
  • Findings should be generalisable to other selective serotonin reuptake inhibitors (SSRIs). 
  • Antidepressive effect may be delayed longer than previously thought.

Study design

  • Pragmatic, multicentre, double-blind PANDA trial randomly assigned patients aged 18-74 years with depression to sertraline (50-mg capsules; n=326) or placebo (n=329) for 12 weeks.
  • Measures included Patient Health Questionnaire, 9-item version (PHQ-9), Generalized Anxiety Disorder Assessment 7-item version (GAD-7), and 12-item Short-Form Health Survey (SF-12).
  • Funding: National Institute for Health Research.

Key results

  • Sertraline yielded no significant improvement in depressive symptoms at 6 weeks vs placebo, defined as adjusted proportional difference (APD) in PHQ-9 (0.95; P=.41).
    • Depressive symptoms improved slightly (by 13%) at 12 weeks (APD, 0.87; 95% CI, 0.79-0.97).
  • Sertraline showed significant benefit over placebo in:
    • Generalised anxiety symptoms at 6 weeks (GAD-7: APD, 0.79; 95% CI, 0.70-0.89) and 12 weeks (APD, 0.77; 95% CI, 0.68-0.87).
    • Mental health-related QoL (SF-12: APD, 2.41; P=.0002).
    • Self-rated improvement (aOR, 1.96; P<.0001>

Limitations

  • Short follow-up.

Coauthored with Chitra Ravi, MPharm