Depressive symptoms including physical pain and impaired social function may improve much faster after starting antidepressant therapy than feelings of hopelessness, and patients may be more compliant with drug therapy if they have clear expectations on the timing of different responses, according to an article in the January-February issue of General Hospital Psychiatry.

Researchers at the University of Michigan Health System studied the timing of different responses to antidepressant therapy in order to understand and predict factors that may influence long-term compliance with antidepressant therapy. The researchers were concerned that a lingering sense of hopelessness despite clear improvements in other symptoms may lead some patients to discontinue drug therapy or even act on feelings of despair and suicidal ideation.

Lead author James E. Aikens, PhD, associate professor in the Department of Family Medicine at the University of Michigan Health System, and his team studied 573 patients with depression, who were given fluoxetine, paroxetine, or sertraline. They were assessed 1, 3, 6 and 9 months after treatment began.

Overall, patients' depression responded rapidly to medication, with 68 percent of their improvements occurring by the end of the first month, and 88 percent by three months. The patients experienced the majority of their improvement in several areas during this time period, including positive emotions, work functioning and social functioning.

Improvements in head, back and stomach pain improved during the first month. Because of little gain was seen after that, Aikens said, physicians may want to consider additional treatments that directly target pain in depressed patients if physical complaints persist after the first few weeks of treatment with antidepressants.

With hopefulness, however, improvement was much more gradual. For many in the study, feelings of hopefulness did not improve until several weeks, or even months, after other depressive symptoms lifted.

Physicians may want to consider cognitive-behavioral strategies, such as teaching patients to identify and challenge the pessimistic thoughts that usually accompany depression, and encouraging them to engage in activities that may improve their mood, Aikens suggested.