{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,5]],"date-time":"2025-10-05T12:20:09Z","timestamp":1759666809626,"version":"3.41.2"},"reference-count":31,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2021,6,17]],"date-time":"2021-06-17T00:00:00Z","timestamp":1623888000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Psychiatry"],"abstract":"<jats:p><jats:bold>Background:<\/jats:bold> Suboptimal treatment response during anti-depressive treatment is fairly common with the first antidepressant (AD) choice, followed by switching to another agent in the majority of cases. However, the efficacy of this strategy over continuation of the original agent is less solidly documented in real-life studies. The aim of our present study was to ascertain the effects of switching to duloxetine following inadequate response to prior ADs on general illness severity, pain, and health-related quality of life in a large sample of major depressive disorder (MDD) and generalized anxiety disorder (GAD) patients in a prospective, real-world, multicenter, observational study.<\/jats:p><jats:p><jats:bold>Methods:<\/jats:bold> A total of 578 participants with MDD or GAD were enrolled in 58 outpatient sites in an 8-week, single-arm, open-label, flexible-dose trial with duloxetine. Severity of symptoms [with Clinical Global Impression-Severity (CGI-S) and Clinical Global Impression-Improvement (CGI-I)], severity of pain (with a Visual Analog Scale), satisfaction with current treatment, and health-related quality of life [with the three-level version of the EuroQol five-dimensional questionnaire (EQ-5D-3L)] measures were recorded at baseline and at follow-up visits 4 and 8 weeks after initiation of treatment. Data were analyzed using ANOVA and mixed linear models.<\/jats:p><jats:p><jats:bold>Results:<\/jats:bold> 565 patients completed the study and comprised the analyzed dataset. Results indicated that severity of illness significantly decreased over the 8 weeks of the study and already at 4 weeks in both patient groups. Overall quality of life and all of its subindicators also significantly improved in both patient groups and so did subjective experience of pain. Satisfaction with current treatment also significantly increased during the study period. Frequency of side effects was low. In both GAD and MDD groups, two patients dropped out of the study due to adverse effects, leading to treatment termination in four cases (0.7%).<\/jats:p><jats:p><jats:bold>Conclusions:<\/jats:bold> This 8-week, multicenter, flexible-dosing, single-arm, open-label, observational real-life study in MDD and GAD patients switched to duloxetine after inadequate response or low tolerability to other ADs showed a significant positive effect on all outcome measures, including a significant decrease in illness severity as well as significant overall symptomatic improvement, with good tolerability.<\/jats:p>","DOI":"10.3389\/fpsyt.2021.689143","type":"journal-article","created":{"date-parts":[[2021,6,17]],"date-time":"2021-06-17T09:56:43Z","timestamp":1623923803000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":5,"title":["A Real-World, Prospective, Multicenter, Single-Arm Observational Study of Duloxetine in Patients With Major Depressive Disorder or Generalized Anxiety Disorder"],"prefix":"10.3389","volume":"12","author":[{"given":"Gyorgy","family":"Szekeres","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sandor","family":"Rozsa","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Peter","family":"Dome","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Gabor","family":"Barsony","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Xenia","family":"Gonda","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2021,6,17]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"Cd007115","DOI":"10.1002\/14651858.CD007115.pub3","article-title":"Duloxetine for treating painful neuropathy, chronic pain or fibromyalgia","volume":"3","author":"Lunn","year":"2014","journal-title":"Cochrane Database Syst Rev"},{"article-title":"Stahl's Essential Psychopharmacology Neuroscientific Basis and Practical Application","year":"2013","author":"Stahl","key":"B2"},{"key":"B3","doi-asserted-by":"publisher","first-page":"281","DOI":"10.2165\/11539240-000000000-00000","article-title":"Duloxetine: clinical pharmacokinetics and drug interactions","volume":"50","author":"Knadler","year":"2011","journal-title":"Clin Pharmacokinet"},{"key":"B4","doi-asserted-by":"publisher","first-page":"772","DOI":"10.3389\/fpsyt.2019.00772","article-title":"Duloxetine in psychiatric disorders: expansions beyond major depression and generalized anxiety disorder","volume":"10","author":"Muscatello","year":"2019","journal-title":"Front Psychiatr"},{"key":"B5","doi-asserted-by":"publisher","first-page":"513","DOI":"10.1111\/jcpt.12534","article-title":"Serotonin-norepinephrine reuptake inhibitors and the influence of binding affinity","volume":"42","author":"Raouf","year":"2017","journal-title":"J Clin Pharm Ther"},{"key":"B6","doi-asserted-by":"publisher","first-page":"197","DOI":"10.4088\/PCC.v10n0304","article-title":"Implications of pain in generalized anxiety disorder: efficacy of duloxetine","volume":"10","author":"Hartford","year":"2008","journal-title":"Prim Care Companion J Clin Psychiatry"},{"key":"B7","first-page":"17","article-title":"Prevalence and management of treatment-resistant depression","author":"Nemeroff","year":"2007","journal-title":"J Clin Psychiatry"},{"key":"B8","doi-asserted-by":"publisher","first-page":"427","DOI":"10.1080\/15622975.2019.1635270","article-title":"Results of the European group for the study of resistant depression (GSRD) - basis for further research and clinical practice","volume":"20","author":"Bartova","year":"2019","journal-title":"World J Biol Psychiatry"},{"key":"B9","doi-asserted-by":"publisher","first-page":"576","DOI":"10.1177\/0706743716660290","article-title":"Canadian network for mood and anxiety treatments (CANMAT) 2016 clinical guidelines for the management of adults with major depressive disorder: section 5. Complementary and alternative medicine treatments","volume":"61","author":"Ravindran","year":"2016","journal-title":"Can J Psychiatry"},{"key":"B10","doi-asserted-by":"publisher","first-page":"166","DOI":"10.1080\/13651501.2017.1306082","article-title":"Pharmacological treatment of unipolar depressive disorders: summary of WFSBP guidelines","volume":"21","author":"Bauer","year":"2017","journal-title":"Int J Psychiatry Clin Pract"},{"key":"B11","doi-asserted-by":"publisher","first-page":"561","DOI":"10.1177\/0706743716660033","article-title":"Canadian network for mood and anxiety treatments (CANMAT) 2016 clinical guidelines for the management of adults with major depressive disorder: section 4. neurostimulation treatments","volume":"61","author":"Milev","year":"2016","journal-title":"Can J Psychiatry"},{"key":"B12","first-page":"218","article-title":"In: Guy W, editor","volume-title":"ECDEU Assessment Manual for Psychopharmacology","author":"Guy","year":"1976"},{"key":"B13","doi-asserted-by":"publisher","first-page":"102","DOI":"10.1213\/00000539-199801000-00020","article-title":"The visual analog scale in the immediate postoperative period: intrasubject variability and correlation with a numeric scale","volume":"86","author":"DeLoach","year":"1998","journal-title":"Anesth Analg"},{"key":"B14","doi-asserted-by":"publisher","first-page":"1095","DOI":"10.1097\/00005650-199711000-00002","article-title":"Modeling valuations for EuroQol health states","volume":"35","author":"Dolan","year":"1997","journal-title":"Med Care"},{"key":"B15","doi-asserted-by":"publisher","first-page":"28","DOI":"10.1176\/appi.ajp.163.1.28","article-title":"Evaluation of outcomes with citalopram for depression using measurement-based care in STAR*D: implications for clinical practice","volume":"163","author":"Trivedi","year":"2006","journal-title":"Am J Psychiatry"},{"key":"B16","doi-asserted-by":"publisher","first-page":"308","DOI":"10.1192\/bjp.168.3.308","article-title":"Phenomenology and course of generalised anxiety disorder","volume":"168","author":"Yonkers","year":"1996","journal-title":"Br J Psychiatry"},{"key":"B17","doi-asserted-by":"publisher","first-page":"2405","DOI":"10.1017\/S0033291718003331","article-title":"Prediction of remission in pharmacotherapy of untreated major depression: development and validation of multivariable prediction models","volume":"49","author":"Furukawa","year":"2019","journal-title":"Psychol Med"},{"key":"B18","doi-asserted-by":"publisher","first-page":"106","DOI":"10.1002\/da.20209","article-title":"Duloxetine for the treatment of major depressive disorder","volume":"36","author":"Nemeroff","year":"2002","journal-title":"Psychopharmacol Bull"},{"key":"B19","doi-asserted-by":"publisher","first-page":"41","DOI":"10.4088\/JCP.v67n0107","article-title":"Remission of generalized anxiety disorder: a review of the paroxetine clinical trials database","volume":"67","author":"Rickels","year":"2006","journal-title":"J Clin Psychiatry"},{"key":"B20","doi-asserted-by":"publisher","first-page":"100","DOI":"10.4088\/PCC.v09n0203","article-title":"Efficacy of duloxetine for the treatment of generalized anxiety disorder: implications for primary care physicians","volume":"9","author":"Koponen","year":"2007","journal-title":"Prim Care Companion J Clin Psychiatr"},{"key":"B21","doi-asserted-by":"publisher","first-page":"21","DOI":"10.1016\/j.jpsychires.2019.08.009","article-title":"Comparative efficacy and acceptability of first-line drugs for the acute treatment of generalized anxiety disorder in adults: a network meta-analysis","volume":"118","author":"He","year":"2019","journal-title":"J Psychiatr Res"},{"key":"B22","doi-asserted-by":"publisher","first-page":"420","DOI":"10.1176\/appi.focus.16407","article-title":"Comparative efficacy and acceptability of 21 antidepressant drugs for the acute treatment of adults with major depressive disorder: a systematic review and network meta-analysis","volume":"16","author":"Cipriani","year":"2018","journal-title":"Focus."},{"key":"B23","first-page":"293","article-title":"Differential effects of alprazolam and imipramine in generalized anxiety disorder: somatic versus psychic symptoms","volume":"49","author":"Hoehn-Saric","year":"1988","journal-title":"J Clin Psychiatry"},{"key":"B24","doi-asserted-by":"publisher","first-page":"293","DOI":"10.1007\/s40263-016-0328-5","article-title":"Unexplained painful physical symptoms in patients with major depressive disorder: prevalence, pathophysiology and management","volume":"30","author":"Jaracz","year":"2016","journal-title":"CNS Drugs"},{"key":"B25","doi-asserted-by":"publisher","first-page":"2426","DOI":"10.3390\/ph3082426","article-title":"The impact of residual symptoms in major depression","volume":"3","author":"Israel","year":"2010","journal-title":"Pharmaceuticals."},{"key":"B26","doi-asserted-by":"publisher","first-page":"e106907","DOI":"10.1371\/journal.pone.0106907","article-title":"The association of depression and anxiety with pain: a study from NESDA","volume":"9","author":"de Heer","year":"2014","journal-title":"PLoS ONE"},{"key":"B27","doi-asserted-by":"publisher","first-page":"17","DOI":"10.1176\/appi.psy.45.1.17","article-title":"Effects of duloxetine on painful physical symptoms associated with depression","volume":"45","author":"Goldstein","year":"2004","journal-title":"Psychosomatics"},{"key":"B28","doi-asserted-by":"publisher","first-page":"39","DOI":"10.2147\/PPA.S24752","article-title":"A literature review to explore the link between treatment satisfaction and adherence, compliance, and persistence","volume":"6","author":"Barbosa","year":"2012","journal-title":"Patient Prefer Adherence"},{"key":"B29","doi-asserted-by":"publisher","first-page":"43","DOI":"10.1186\/1471-244X-7-43","article-title":"Duloxetine in the treatment of major depressive disorder: an open-label study","volume":"7","author":"Hudson","year":"2007","journal-title":"BMC Psychiatry"},{"key":"B30","doi-asserted-by":"publisher","first-page":"308","DOI":"10.4088\/JCP.v63n0407","article-title":"Duloxetine, 60 mg once daily, for major depressive disorder: a randomized double-blind placebo-controlled trial","volume":"63","author":"Detke","year":"2002","journal-title":"J Clin Psychiatry"},{"key":"B31","doi-asserted-by":"publisher","first-page":"383","DOI":"10.1016\/S0022-3956(02)00060-2","article-title":"Duloxetine 60 mg once daily dosing versus placebo in the acute treatment of major depression","volume":"36","author":"Detke","year":"2002","journal-title":"J Psychiatr Res"}],"container-title":["Frontiers in Psychiatry"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fpsyt.2021.689143\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2021,6,17]],"date-time":"2021-06-17T09:56:48Z","timestamp":1623923808000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fpsyt.2021.689143\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,6,17]]},"references-count":31,"alternative-id":["10.3389\/fpsyt.2021.689143"],"URL":"https:\/\/doi.org\/10.3389\/fpsyt.2021.689143","relation":{},"ISSN":["1664-0640"],"issn-type":[{"type":"electronic","value":"1664-0640"}],"subject":[],"published":{"date-parts":[[2021,6,17]]},"article-number":"689143"}}