Negative association of concomitant physical symptoms with the course of major depressive disorder: a systematic review.

OBJECTIVE The prognosis of depression greatly varies among patients, and the physical symptoms that often accompany depression may predict treatment resistance and a worse outcome. If so, this may have important clinical implications. The aim of this systematic review was to explore the association of concomitant physical symptoms with the outcome of major depressive disorder (MDD). METHODS Systematic review: Medline, Psychinfo, and the Cochrane Library were searched for prospective, cross-sectional, and retrospective studies, and also for open-label trials and randomized controlled trials. The risk of bias assessment and data extraction were performed in duplicate. A qualitative best-evidence synthesis was performed, based on the number of studies reporting on the association between physical symptoms and the course of MDD, the consistency of the results, and the methodological quality. The findings were reported according to the PRISMA guidelines. RESULTS Nine studies met the inclusion criteria. Although the design, outcome measures, and data presentation varied too much to make statistical pooling possible, the best evidence synthesis resulted in strong, consistent evidence for a negative association between physical symptoms and the course of MDD. CONCLUSION This systematic review shows a negative association of concomitant physical symptoms with the course of MDD. The effect might be considerable, but the number of studies addressing this topic is small and there was a wide variation in the study designs and outcome measures. More research is needed.