Duloxetine plus exercise for knee osteoarthritis and depression: A feasibility study

Area of Science:

• Gerontology
• Rehabilitation Medicine
• Psychiatry

Background:

• Symptomatic knee osteoarthritis (OA) frequently co-occurs with major depression, impacting patient quality of life.
• Current treatment guidelines lack specific recommendations for managing this dual diagnosis.
• Exercise and pharmacotherapy (duloxetine) are individually indicated for OA and depression, respectively.

Purpose of the Study:

• To assess the feasibility of a 24-week, center-based, aerobic exercise program combined with duloxetine for patients with symptomatic knee OA and major depression.
• To evaluate recruitment rates, dropout reasons, and treatment adherence for this combined intervention.

Main Methods:

• A 24-week intervention involving supervised treadmill walking (3x weekly) and duloxetine (30-60 mg/day).
• Recruitment occurred between August 2021 and November 2022 from academic health systems and the community.
• Feasibility assessed via recruitment, adherence, and clinical outcomes (KOOS, HAM-D) at baseline, 12, and 24 weeks.

Main Results:

• Only 9 out of 377 interested individuals were enrolled, with just 1 completing the study.
• Primary barriers included time commitment for exercise and stringent depression diagnostic criteria.
• The single completer showed improved depression scores (HAM-D) but low exercise adherence (26%) and minimal change in knee pain (KOOS).

Conclusions:

• The combined aerobic exercise and duloxetine intervention demonstrated low feasibility for treating knee OA with major depression.
• Accessibility was limited by the time commitment required for supervised exercise.
• Diagnostic criteria for major depression excluded patients with depressive symptoms not meeting case-level diagnosis, hindering broader application.