Sertraline has early effect on key depressive symptoms, finds updated study
One of the most common antidepressants is associated with early improvement in key depressive symptoms, including low mood, within two weeks, say researchers.
It follows a previous study in 2019 which found that sertraline may have an earlier impact on symptoms related to anxiety than those associated with depression.
But a more detailed analysis on 571 participants in the PANDA trial by researchers at University College London has now shown the true picture is more nuanced.
It suggests that including all depressive symptoms together in the initial analysis had obscured the benefits of sertraline on some of the core depressive symptoms, they wrote in Nature Mental Health.
In the updated analysis, the early improvements from sertraline were found to be on feelings of sadness, self-loathing, restlessness, and suicidal thoughts, they reported.
Side effects of the drug led to symptoms such as low libido, low appetite, and tiredness, which can also be symptoms of depression.
The original study reported that sertraline improved anxiety symptoms and people reported an overall improvement in their mental health, but there was no meaningful impact on depressive symptoms for 12 weeks.
Now researchers say that sertraline contributed to improvements in anxiety symptoms and in the emotional symptoms of depression within two weeks, and a modest worsening of somatic symptoms.
The effect on somatic symptoms plateaued after six weeks, while the improvements in emotional symptoms and anxiety continued to improve from six weeks to 12 weeks, they found.
Lead author of the updated analysis, Dr Giulia Piazza, a research fellow within UCL Psychiatry, said they had shown a more complex picture of sertraline’s effects on the different symptoms of depression.
‘Instead of thinking of depression and anxiety as each being a single, uniform condition, network analysis considers that they’re each a constellation of symptoms, that can appear in different combinations for different people.
‘These symptoms influence each other over time; for example, poor sleep can lead to problems with concentration, which may then impact self-esteem.’
Co-author Professor Glyn Lewis, who led the PANDA trial, said: ‘Our findings provide robust evidence that continues to support the prescription of sertraline for people experiencing depressive and anxiety symptoms.
‘These findings will help patients and clinicians to make more informed decisions about treatment.’
Dr Atheeshaan Arumuham, an academic clinical fellow in the Institute of Psychiatry, Psychology and Neuroscience at King’s College London, said the analysis provided a ‘much-needed update’.
‘By analysing data from a large, pragmatic randomised control trial of sertraline in primary care, researchers looked beyond total depression scores and instead examined the impact of treatment on individual symptoms.
‘Their findings are clinically important as they shed light on why antidepressants sometimes appear ineffective in trials or public debate.’
He said traditional depression rating scales often include psychological components, such as sadness and self-worth, as well as physical health components too like sleep, libido, and appetite.
‘Importantly, these physical health aspects can also be affected as adverse effects of antidepressants. When these are bundled into a single score, they can mask real improvements in mood and anxiety.’
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