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The complex clinical response to selective serotonin reuptake inhibitors in depression: a network perspective

The clinical response to selective serotonin reuptake inhibitors (SSRIs) in depression takes weeks to be fully developed and is still not entirely understood. This study aimed to determine the direct and indirect effects of SSRIs relative to a placebo control condition on clinical symptoms of depres...

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Autores principales: Boschloo, Lynn, Hieronymus, Fredrik, Lisinski, Alexander, Cuijpers, Pim, Eriksson, Elias
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Nature Publishing Group UK 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9867733/
https://www.ncbi.nlm.nih.gov/pubmed/36681669
http://dx.doi.org/10.1038/s41398-022-02285-2
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author Boschloo, Lynn
Hieronymus, Fredrik
Lisinski, Alexander
Cuijpers, Pim
Eriksson, Elias
author_facet Boschloo, Lynn
Hieronymus, Fredrik
Lisinski, Alexander
Cuijpers, Pim
Eriksson, Elias
author_sort Boschloo, Lynn
collection PubMed
description The clinical response to selective serotonin reuptake inhibitors (SSRIs) in depression takes weeks to be fully developed and is still not entirely understood. This study aimed to determine the direct and indirect effects of SSRIs relative to a placebo control condition on clinical symptoms of depression. We included data of 8262 adult patients with major depression participating in 28 industry-sponsored US Food and Drug Administration (FDA) registered trials on the efficacy of SSRIs. Clinical symptoms of depression were assessed by the 17 separate items of the Hamilton Depression Rating Scale (HDRS) after 1, 2, 3, 4 and 6 weeks of treatment. Network estimation techniques showed that SSRIs had quick and strong direct effects on the two affective symptoms, i.e., depressed mood and psychic anxiety; direct effects on other symptoms were weak or absent. Substantial indirect effects were found for all four cognitive symptoms, which showed larger reductions in the SSRI condition but mainly in patients reporting larger reductions in depressed mood. Smaller indirect effects were found for two arousal/somatic symptoms via the direct effect on psychic anxiety. Both direct and indirect effects on sleep problems and most arousal/somatic symptoms were weak or absent. In conclusion, our study revealed that SSRIs primarily caused reductions in affective symptoms, which were related to reductions in mainly cognitive symptoms and some specific arousal/somatic symptoms. The results can contribute to disclosing the mechanisms of action of SSRIs, and has the potential to facilitate early detection of responders and non-responders in clinical practice.
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spelling pubmed-98677332023-01-23 The complex clinical response to selective serotonin reuptake inhibitors in depression: a network perspective Boschloo, Lynn Hieronymus, Fredrik Lisinski, Alexander Cuijpers, Pim Eriksson, Elias Transl Psychiatry Article The clinical response to selective serotonin reuptake inhibitors (SSRIs) in depression takes weeks to be fully developed and is still not entirely understood. This study aimed to determine the direct and indirect effects of SSRIs relative to a placebo control condition on clinical symptoms of depression. We included data of 8262 adult patients with major depression participating in 28 industry-sponsored US Food and Drug Administration (FDA) registered trials on the efficacy of SSRIs. Clinical symptoms of depression were assessed by the 17 separate items of the Hamilton Depression Rating Scale (HDRS) after 1, 2, 3, 4 and 6 weeks of treatment. Network estimation techniques showed that SSRIs had quick and strong direct effects on the two affective symptoms, i.e., depressed mood and psychic anxiety; direct effects on other symptoms were weak or absent. Substantial indirect effects were found for all four cognitive symptoms, which showed larger reductions in the SSRI condition but mainly in patients reporting larger reductions in depressed mood. Smaller indirect effects were found for two arousal/somatic symptoms via the direct effect on psychic anxiety. Both direct and indirect effects on sleep problems and most arousal/somatic symptoms were weak or absent. In conclusion, our study revealed that SSRIs primarily caused reductions in affective symptoms, which were related to reductions in mainly cognitive symptoms and some specific arousal/somatic symptoms. The results can contribute to disclosing the mechanisms of action of SSRIs, and has the potential to facilitate early detection of responders and non-responders in clinical practice. Nature Publishing Group UK 2023-01-21 /pmc/articles/PMC9867733/ /pubmed/36681669 http://dx.doi.org/10.1038/s41398-022-02285-2 Text en © The Author(s) 2023 https://creativecommons.org/licenses/by/4.0/Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons license, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons license and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this license, visit http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) .
spellingShingle Article
Boschloo, Lynn
Hieronymus, Fredrik
Lisinski, Alexander
Cuijpers, Pim
Eriksson, Elias
The complex clinical response to selective serotonin reuptake inhibitors in depression: a network perspective
title The complex clinical response to selective serotonin reuptake inhibitors in depression: a network perspective
title_full The complex clinical response to selective serotonin reuptake inhibitors in depression: a network perspective
title_fullStr The complex clinical response to selective serotonin reuptake inhibitors in depression: a network perspective
title_full_unstemmed The complex clinical response to selective serotonin reuptake inhibitors in depression: a network perspective
title_short The complex clinical response to selective serotonin reuptake inhibitors in depression: a network perspective
title_sort complex clinical response to selective serotonin reuptake inhibitors in depression: a network perspective
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9867733/
https://www.ncbi.nlm.nih.gov/pubmed/36681669
http://dx.doi.org/10.1038/s41398-022-02285-2
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