Characteristics Of Patients With Major Depressive Disorder And Comorbid Functional Dyspepsia And A Randomized Controlled Treatment Study

Background:Major Depressive Disorder (MDD) causes severe public health burden. GI symptoms were noted in all MDD patients in a previous study of our team and might be so persistent and outstanding that some MDD patients meet the Rome â…¢ criteria for Functional Dyspepsia (FD). Associated with depression is often noted among FD patients. In our previous finding, patients with both MDD and FD had more consultation times per year and spent much more on health than patients just with MDD or FD. Furthermore, these patients paid more attention on their GI symptoms and consulted digestive physician repeatedly. However, there is no standardized therapeutic regimen in clinical practice and no common view on the treatment effect of these comorbid patients.Objectives:1) to know about clinical characteristics of patients with both MDD and FD; 2) to compare the effect for symptoms of depression and dyspepsia between one-drug and combine-drug regimen.3) to observe results of gastric emptying and electrogastrography and explore the physiopathology of these comorbid patients.Method:The research was conducted in a general hospital. Patients met DSM-IV criteria for major depressive disorder (MDD) and Rome â…¢ criteria for functional dyspepsia (FD) were continuously enrolled from psychological medicine department and FGID clinic in gastroenterology department. All patients were offered with clinical referral to the other department for professional clinical diagnosis. Patients were randomly assigned to the one-drug (n=20) or to combine-drug (n=20). The one-drug group consisted of 8 weeks of optimized SSRI (Selective Serotonin Reuptake Inhibitor) therapy and clinical management; in the combine-drug group, besides optimized SSRI and clinical management, it consisted of one certain kind of proton pump inhibitors and/or prokinetics. The depressive symptoms, dyspepsia symptoms and quality-of-life should be assessed at baseline, 2-week,4-week and 8-week. Gastric emptying and electrogastrography should be done at baseline and 8-week.Results:Forty patients with both MDD and FD were recruited. Overall, the mean age was 46.53 years; 72.5% were women; median months of MDD and FD were both 12.00; the mean HAMD-17 was 23.37, the mean DSS was 17.83; the PCS and MCS in SF-36 was 38.52 and 23.49, respectively; at baseline,35.7% had delayed gastric emptying, and there were higher percentage of brandygastria and tachygastria in the fed state. After 8 weeks,15 of the 20 in the one-drug group (75.0%) had a composite response from baseline compared with 11 of 20 in the combine-drug group (55.0%), but there is no statistical difference (p=0.185). As to quality-of-life outcomes (SF-36), the one-drug group had better outcomes in terms of RP, RE, MH and MCS. The results of gastric emptying and electrogastrography did not improve significantly in either group.Conclusion:for patients with MDD and FD, antidepressant drug can be the core therapy which has a remarkable treatment effect. We did not find significant differences of treatment effect between the two regimens. The one-drug group had better outcomes of quality-of-life.