What do patients want from their treatment?

MDD is the leading cause of disability worldwide with high morbidity and mortality,¹ said Professor Siegfried Kasper, Medical University of Vienna, Austria. Initiation of treatment is therefore of utmost importance, but which treatment?

Patients’ expectations of treatment differ

Relationship between symptoms and function

Professor Dan Stein, University of Cape Town, South Africa highlighted the heterogeneity of MDD. Each patient has their own unique combination of symptoms,² resulting in differing effects on personal, social, and work function.

Patients’ expectations of their treatment therefore differ, and treatment needs to be tailored to the patient, he said.

Each patient has a unique experience of MDD

Professor Sidney Kennedy, University of Toronto, Canada described how different symptoms affect a patient’s ability to function:

• Overall, sad mood, concentration problems, fatigue, and loss of interest have most impact on psychosocial function³
• Low energy is experienced by 91% of patients and is more predictive of poorer work and social functioning than other depressive symptoms, and improvement in energy is more strongly related to improved work productivity⁴
• Improving motivation predicts early improvement and has the best predictive value for response⁵

Treatment goals

The most important goals are positive mental health and a return to one's usual self and life

Patients and doctors need to have the same treatment goals, said Professor Kasper, and this is best achieved by shared decision making.

A patient-centered approach using a goal attainment scale to establish and track progress toward treatment goals that are meaningful to patients has been advocated.⁶

Professor Kasper noted that for the majority of patients who have set such goals, the goals concern:

• physical health
• cognitive functioning
• social aspects of life⁷ 

The most important goals are positive mental health (e.g. optimism and self-confidence) and a return to one's usual self and level of functioning,⁸ he said.

In addition, it is important to note that a patient’s preference for a particular treatment is a potent moderator of response to the treatment.⁹

Which antidepressant?

Antidepressants differ in efficacy and acceptability

All antidepressants are more effective than placebo in the treatment of MDD, but differences in efficacy and acceptability between different antidepressants have been demonstrated in head-to head-trials,¹⁰ said Professor Stein.

These were the findings of a systematic review and network meta-analysis by Cipriani et al. published in The Lancet in 2018.

Cipriani et al. concluded that their results should serve evidence-based practice and inform patients, physicians, guideline developers, and policy makers in their decision-making on the use of different antidepressants.¹⁰

Support for this satellite symposium at WCP 2021 was provided by Servier