A Preliminary Study of Different Treatment Strategies for Anxious Depression

Yun Wang, Xiaohua Liu, Daihui Peng, Yan Wu, Yun'ai Su, Jia Xu, Xiancang Ma, Yi Li, Jianfei Shi, Xiaojing Cheng, Han Rong, Yiru Fang, Yun Wang, Xiaohua Liu, Daihui Peng, Yan Wu, Yun'ai Su, Jia Xu, Xiancang Ma, Yi Li, Jianfei Shi, Xiaojing Cheng, Han Rong, Yiru Fang

Abstract

Background: Despite the best treatments, about 20% of patients with major depressive disorder (MDD) receiving drugs and psychological intervention show little or no improvement. There is no trial comparing different treatment methods in patients with anxiety/somatic subtype MDD.

Aim: To compare the efficacy and safety of various treatments in patients with anxiety/somatic subtype MDD.

Methods: This was a preliminary multicenter randomized controlled trial at eight participating hospitals in China (09/2016-06/2019) (ClinicalTrials.gov #NCT03219008). The patients were randomized to mirtazapine/SNRIs, mirtazapine/SNRIs+cognitive behavioral therapy (CBT), mirtazapine+SNRIs, or mirtazapine+SNRIs+physical therapies (modified electroconvulsive treatment or repetitive transcranial magnetic stimulation). The primary endpoint was the 17-item Hamilton Depression Scale (HAMD-17). The Quick Inventory of Depressive Symptomatology-Self-Report (QIDS-SR) and Quality of Life (QOL)-6 were the secondary endpoints. The adverse events (AEs) were monitored. The patients were assessed at baseline (0 weeks), and at the end of the 2nd, 4th, 6th, 8th, and 12th week during treatment.

Results: Finally, 107 patients were included: mirtazapine/SNRIs (n=36), mirtazapine/SNRIs+CBT (n=28), mirtazapine+SNRIs (n=29), and mirtazapine+SNRIs+physical therapies (n=14). The 17-HDRS and QIDS-SR scores decreased in all four groups, and the QOL-6 scores increased. There were no differences in the 17-HDRS (P=0.099), QIDS-SR (P=0.407), and QOL-6 (P=0.485) scores among the four groups. There were no differences in the occurrence of AEs among the four groups (P=0.942).

Conclusion: This preliminary trial suggests that all four interventions (mirtazapine/SNRIs, mirtazapine/SNRIs+CBT, mirtazapine+SNRIs, or mirtazapine+SNRIs+physical therapies) achieved similar response and remission rates in patients with anxiety/somatic subtype MDD. The safety profile was manageable.

Keywords: Hamilton Depression Scale; anxiety; cognitive behavioral therapy; major depressive disorder; mirtazapine; serotonin-norepinephrine reuptake inhibitor.

Conflict of interest statement

All authors declare that they have no competing interests.

© 2022 Wang et al.

Figures

Figure 1
Figure 1
Observation indexes over the course of the 12-week treatment in patients with anxious depression. (A) 17-item Hamilton Depression Rating Scale (17-HDRS). (B) Quick Inventory of Depressive Symptomatology - Self-Reported (QIDS-SR). (C) Quality of life (QOL)-6.

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