Comparison of duloxetine and SSRI as a treatment option of painful physical symptoms associated with major depressive disorder
Miqdad Haider,1 Muhammad Nabeel Shafqat2
1Department of Medicine, Fatima Memorial Hospital, Fatima Memorial College of Medicine and Dentistry, Lahore, Pakistan; 2Department of Medicine, University of Medical Sciences “Serafin Ruiz de Zarate” Villa Clara (UCMVC), Villa Clara, Cuba
We would like to write about the recently published article “An observational study of duloxetine versus selective serotonin reuptake inhibitors (SSRIs) monotherapy for the treatment of painful physical symptoms in Japanese patients with major depressive disorder: primary analysis” by Kuga et al, which we read with great interest.1 The study is a good step toward finding the best treatment option for painful physical symptoms (PPSs) in patients with major depressive disorder (MDD).
Atsushi Kuga,1 Toshinaga Tsuji,2 Shinji Hayashi,2 Mako Matsubara,3 Shinji Fujikoshi,4 Hirofumi Tokuoka,1 Aki Yoshikawa,5 Rodrigo Escobar,6 Kazuhide Tanaka,7 Takaharu Azekawa8
1Bio Medicine, Medicines Development Unit Japan, Eli Lilly Japan K.K., Kobe, 2Medical Affairs Department, 3Pharmacovigilance Department, Shionogi & Co. Ltd, Osaka, 4Statistical Science, 5Scientific Communications, Medicines Development Unit Japan, Eli Lilly Japan K.K., Kobe, Japan; 6Bio-Medicines, Eli Lilly and Company, Indianapolis, IN, USA; 7Hitsuji Clinic, Kusatsu, Japan; 8Shioiri Mental Clinic, Yokosuka, Japan
We appreciate Drs Haider and Shafqat’s close reading of our manuscript. As they mentioned, the noradrenergic action of serotonin-norepinephrine reuptake inhibitors (SNRIs) on descending pain modulation pathways may explain its advantageous effect on painful physical symptoms (PPSs) in patients with major depressive disorder (MDD).1 In reference to the report by our colleagues regarding the effect of duloxetine on PPS in MDD,2 they stated that any treatment plan for depression that ignores physical symptoms may lead to failure of remission and poor prognosis. Harada et al2 in their report were very much aware of this and showed that initially the direct effect of duloxetine on PPS associated with MDD was greater than its indirect effect, whereas later the indirect effect through improvement in depressive symptoms predominated. In our study,3 we were concerned with showing how to optimize the treatment of MDD with PPS. This clinical question led us to plan our study comparing duloxetine and selective serotonin reuptake inhibitors (SSRIs).3,4
View the original paper by Kuga and colleagues.
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