World Mental Health Day October 7th and PANDA study

October, 2019

Antidepressants may reduce anxiety more than depressive symptoms

On World Mental Health Day, WONCA draws attention to an important new study of antidepressant prescribing in primary care.

One of the most common antidepressants, sertraline, leads to an early reduction in anxiety symptoms, commonly found in depression, several weeks before any improvement in depressive symptoms, a UK clinical trial has found.

Published in The Lancet Psychiatry and funded by the National Institute for Health Research (NIHR), this is the largest-ever placebo-controlled trial of an antidepressant, which has not been funded by the pharmaceutical industry.

By involving a wide range of patients including people with mild to moderate symptoms, the researchers surveyed a much wider group of people than most previous clinical trial samples.

Sertraline did not appear to improve depressive symptoms, which include low mood, loss of pleasure and poor concentration, within six weeks. However, there was weak evidence that sertraline reduced depressive symptoms by 12 weeks.

“It appears that people taking the drug are feeling less anxious, so they feel better overall, even if their depressive symptoms were less affected,” said the study’s lead author, Dr Gemma Lewis (UCL Psychiatry).
Sertraline is a selective serotonin reuptake inhibitor (SSRI), the most common class of antidepressants.

The study was conducted in GP surgeries, and included 655 people in England, aged 18 to 74, with depressive symptoms of any severity or duration in the past two years. In all cases, there was clinical uncertainty about whether to prescribe an antidepressant.

The researchers say the participants were more representative of the people now receiving antidepressants in the UK than in previous trials.

The large majority of people with depression also experience anxiety symptoms, and antidepressants are the standard pharmaceutical treatment for generalised anxiety disorder.

Half of the participants were given sertraline for 12 weeks, while the other half were randomly assigned to the control group and given placebo pills for 12 weeks.

Co-author Professor Christopher Dowrick, Chair of the WONCA Working Party for Mental Health, commented: “This study has important messages for family doctors worldwide. If family doctors are uncertain whether to prescribe an antidepressant for a patient with depressive symptoms, it is more likely to be helpful if the patient also has symptoms of anxiety”.

The study was conducted at University College London and the Universities of Bristol, Liverpool, and York.

The reference for this paper is:
Lewis G, Duffy L, Ades A, Amos R, Araya R, Brabyn S, et al. The clinical effectiveness of sertraline in primary care and the role of depression severity and duration ( PANDA ): a pragmatic , double-blind , placebo-controlled randomised trial. Lancet Psychiatry. Open Access; 2019;0366:1–12. Available from: http://dx.doi.org/10.1016/S2215-0366(19)30366-9