ORIGINAL ARTICLE Effectiveness of antidepressants in the treatment of major depressive disorder in Latin America HE ´ CTOR J. DUEN ˜ AS 1 , TRISHA DWIGHT 2 , MARGARET E. MCBRIDE 2 , ALAN J.M. BRNABIC 2 , LUIS A. SEMPER 3 , DAGMAR HOLMGREN 4 , ANGELA M.A. MIRANDA-SCIPPA 5 , HERNA ´ N G. RINCO ´ N 6 , HE ´ CTOR AGUILERA 7 & ADRIAN VARGAS 8 1 Eli Lilly and Company, Mexico, 2 Clinical Outcomes and Research Institute, Eli Lilly Australia Pty Limited, Sydney, Australia, 3 Instituto Semper, Corrientes, Argentina, 4 Hospital Naval Almirante Nef de Vin ˜a de Mar, Vin ˜a del Mar, Chile, 5 Department of Psychiatry, Federal University of Bahia, Salvador, Brazil, 6 Fundacio ´n Clı ´nica Valle de Lili, Cali, Colombia, 7 Clı ´nica El Cedral, Caracas, Venezuela, and 8 Clı ´nica San Rafael, Me ´xico City, Mexico Abstract Objective. Painful physical symptoms occur frequently in patients with major depressive disorder (MDD), and although numerous studies report the effect of antidepressants on emotional aspects of depression, few focus on their effect on physical symptoms. This observational study was conducted, in a clinical practice setting, to determine antidepressant treatment decisions and their outcome on the physical and emotional symptoms of MDD. Methods. Patients with a mean score ] /2 for pain-related items on the Somatic Symptom Inventory (SSI) were classified with painful physical symptoms (PPS /) and differentiated from the remaining patients (PPS  /). Severity of depression and physical pain were determined using the 17-item Hamilton Depression Rating Scale (HAMD 17 ) and Clinical Global Impressions of Severity Scale (CGI- S), and Visual Analog Scale (VAS), respectively. Results. At baseline, 72.6% of patients were PPS /. Compared to PPS- patients, PPS /patients were, on average, significantly more depressed at baseline (mean difference [95% CI]: HAMD 17 4.6 [3.6, 5.5] and CGI-S 0.3 [0.2, 0.4]; all p B /0.0001), and remained more depressed and in greater pain at endpoint (HAMD 17 p  /0.0074, CGI-S P  / 0.0151, and VAS P B / 0.0001). In addition, fewer PPS / patients (65.8%) achieved remission (total HAMD 17 5 /7) compared to PPS- patients (74.6%, P  / 0.0180). Conclusions. Painful physical symptoms are prevalent in MDD patients, highlighting the importance of addressing both the physical and emotional symptoms of depression. Key Words: Major depressive disorder, painful physical symptoms, antidepressants, observational study Introduction Depression is a multifaceted disorder that encom- passes both emotional and physical symptoms [1], and affects an estimated 340 million people world- wide [2]. Although approximately 70% of depressed patients taking antidepressants respond to treat- ment, only 25  35% of these patients may achieve complete remission (with HAMD 17 cut-off scores ranging from 7 to 11; [3]). Recent studies have shown that painful physical symptoms, such as neck and back pain, headache, stomach pain, fatigue, and non-specific generalised pain occur in as many as 76% of patients with major depressive disorder (MDD [4  9]). Failure to address the physical symptoms associated with depression may contri- bute to a less than optimal remission rate [10], while the risk of relapse may also increase [11]. In addition, the presence of painful physical symptoms has been associated with greater depression severity [7,12]. Addressing the painful physical symptoms, as well as the emotional symptoms, in the treatment of MDD patients may improve the outcomes in some patients. Although a response to antidepressant treatment is the initial aim from a clinical perspective, the long- term goal is to achieve sustained remission (the resolution of depressive symptomatology, both emo- tional and physical [13]). Failure to address the physical symptoms associated with MDD may ultimately decrease a patient’s chance of achieving full remission [4,13]. In addition, patients who Correspondence: Trisha Dwight, PhD, Clinical Outcomes and Research Institute (CORI), Eli Lilly Australia Pty Limited, Level 1, 16 Giffnock Avenue, Macquarie Park NSW 2113, Australia. Tel:  /61 2 8874 5832. Fax:  /61 2 8874 5733. E-mail: tdwight@lilly.com International Journal of Psychiatry in Clinical Practice, 2007; 11(2): 129  139 (Received 22 December 2005; accepted 22 July 2006) ISSN 1365-1501 print/ISSN 1471-1788 online # 2007 Taylor & Francis DOI: 10.1080/13651500600969129