Sequential improvement of anxiety, depression and anhedonia with sertraline treatment in patients with major depression

Abstract

Objective: To establish the therapeutic effect pro®le of sertraline in major depression. It was hypothesized that the antidepressant effect of sertraline showed three phases: Phase 1 where improvements in anxiety are most pronounced; Phase 2 where the greatest improvements are in depressive symptoms; and Phase 3 where the symptoms of anhedonia show the most improvement. To test this hypothesis, an 8-week, openlabel study was conducted. Methods: Patients with a major depressive episode (DSM-IV) and a score ³24 on the 17-item HAM-D were enrolled and treated with sertraline 50±150 mg/day. The three symptomatic clusters, anxiety, depression and hedonia, were de®ned a priori using the Inventory of Depressive Symptomatology-Clinician rated (IDS-C). Periods of interest were: Days 0±7 for anxiety, Days 7±21 for depression and Days 21±56 for anhedonia. Raters were blinded as to the constitution of the clusters and periods. Results: 140 patients were recruited. Improvement in the anxiety cluster of the IDS-C was greatest during Days 0±7, whereas over Days 7±21 most improvement was observed in the depression cluster and the greatest improvement in the hedonic cluster occurred during Days 21±56. Conclusions: These preliminary results are consistent with the hypothesis that the therapeutic effects of sertraline occur in a sequential manner. The symptoms of anxiety improved ®rst, followed by depression and then anhedonia.

Trajectory of criterion symptoms of major depression under newly started antidepressant treatment: sleep disturbances and anergia linger on while suicidal ideas and psychomotor symptoms disappear early

“…These results are somewhat at odds with the summary of symptom trajectories described earlier by Boyer et al , Chekroud et al , or by Kasahara et al . Boyer et al's depression cluster contained symptoms of insomnia, fatigability, and psychomotor retardation, while their hedonic cluster included those of suicidal thoughts and anhedonia; if our observation of individual criterion symptoms were correct, it would mean that their clusters contained symptoms of fast and slow recovery and may well have been unable to detect important differences among them. The situation is similar for Chekroud et al's observation.…”

“…Only a few studies have followed the course of individual symptoms of depression through the acute phase treatment; for example, Boyer et al observed that anxiety disappeared first, followed by depression, then by anhedonia under the eight‐week treatment with sertraline . Chekroud et al observed that the trajectories of core emotional symptoms of depression showed faster reduction than those of sleep symptoms, which in turn showed faster improvement than those of atypical symptoms.…”

Effectiveness of agomelatine on anhedonia in depressed patients: an outpatient, open-label, real-world study

“…In contrast, and in line to the mode of action of SSRI, a study with sertraline administered to depressed patients showed that depression and anxiety responded earlier to the antidepressant than the improvement of anhedonia (Boyer, Tassin, Falissart, & Troy, 2000).…”

SHAPS-C: The Snaith-Hamilton Pleasure Scale modified for clinician administration

“…In-depth measurement of hedonic capacity along with the measurement of mood and behavior is important in depression treatment studies (Boyer, Tassin, Falissart, & Troy, 2000). Self-administered assessments may not be sufficient, particularly in severe psychiatric conditions.…”