Associations between gastrointestinal symptoms, medication use, and spontaneous drug discontinuation in patients with major depressive disorder in China

Abstract

Background: The study was designed to investigate the associations between gastrointestinal (GI) symptoms, medication use, and spontaneous drug discontinuation (SDD) in patients with major depressive disorder (MDD).

Methods: This cross-sectional study included 3256 MDD patients from the National Survey on Symptomatology of Depression (NSSD). Differences in the sociodemographic factors, clinical characteristics, medication use, and self-reported reasons for SDD were compared in patients with different frequencies of GI symptoms. A multiple logistic regression analysis was employed to assess the contribution of GI symptoms to the risk of spontaneous drug discontinuation.

Results: MDD patients with a higher frequency of GI symptoms were prone to have higher proportions of mood stabilizer and benzodiazepine uses (p_{s for trend} < 0.001) but a lower proportion of SNRI use (p_{for trend} < 0.001). With the increase in GI symptoms, patients were prone to report worries about long-term side effects (p_{for trend} < 0.001), with the patients stating ineffective treatments (p_{for trend} = 0.002) and intolerance of adverse drug reactions (p_{for trend} = 0.022) as the reasons for SDD. Compared with those patients without GI symptoms, all of the MDD patients with GI symptom frequencies of several days (OR = 1.317; 95 % CI: 1.045-1.660), more than half of all days (OR = 1.305; 95 % CI: 1.005-1.695), and nearly every day (OR = 1.820; 95 %: 1.309-2.531) had an increased risk of SDD.

Conclusion: GI symptoms are highly associated with drug discontinuation in MDD patients. These findings may have important implications for clinical treatment options, as well as for drug adherence management, in MDD patients.

Keywords: Antidepressant; Drug-gut interaction; Gastrointestinal symptoms; Major depressive disorder; Spontaneous drug discontinuation.