Early adverse events and attrition in selective serotonin reuptake inhibitor treatment: a suicide assessment...

Area of Science:

• Psychiatry
• Clinical Psychology
• Pharmacology

Background:

• Adverse events during selective serotonin reuptake inhibitor (SSRI) treatment are common and often lead to patients discontinuing medication.
• Understanding factors influencing treatment discontinuation is crucial for improving patient retention and outcomes in major depressive disorder (MDD).

Purpose of the Study:

• To investigate whether specific adverse effects or global ratings of adverse effect burden at week 2 predict patient attrition in an 8-week SSRI treatment trial for major depressive disorder.
• To determine if early-emerging or worsening side effects are associated with patients leaving treatment prematurely.

Main Methods:

• Outpatient participants (n=265) with nonpsychotic MDD were enrolled in an 8-week SSRI trial.
• Adverse effects were assessed at baseline and week 2 using the Systematic Assessment for Treatment Emergent Events--Systematic Inquiry.
• Global adverse effect ratings (frequency, intensity, burden) were collected at week 2 using the Frequency, Intensity, and Burden of Side Effects Rating.
• Attrition was defined as discontinuation between week 2 and week 8.

Main Results:

• No specific week 2 adverse effect, whether newly emerged or worsening in intensity, was independently associated with patient attrition.
• Global assessments of adverse effect frequency, intensity, or burden at week 2 did not predict subsequent treatment discontinuation.
• Neither specific side effects nor global ratings at week 2 were related to patients leaving the SSRI treatment early.

Conclusions:

• Early adverse events or their perceived burden in the first two weeks of SSRI treatment do not appear to be a primary driver of patient attrition in major depressive disorder.
• Factors beyond early-emerging side effects likely influence patient decisions to continue or discontinue SSRI treatment.
• Further research is needed to identify other key predictors of treatment retention in patients receiving SSRIs for depression.