Coexisting depressive symptoms do not limit the benefits of chronic neuromodulation: A study of over 200 patients. Issue 2 (1st August 2017) - Killinger, Kim A.
Abstract : Aims: To examine the relationship between coexisting depressive symptoms and outcomes after staged neuromodulation procedures for refractory urological symptoms. Methods: Adults who enrolled in a prospective database and completed a Personal Health Questionnaire Depression Scale (PHQ‐8) at baseline were reviewed. The PHQ‐8 and Generalized Anxiety Disorder (GAD‐7) assessed depressive/anxiety symptoms pre and 6 months post device implant. Urological symptoms were assessed with The Interstitial Cystitis Symptom Index/Problem Index (ICSI‐PI) and Overactive Bladder Questionnaire (OAB‐q) at baseline, 3 and 6 months, and Global Response Assessments (GRA) post implant. Subjects, grouped by PHQ <10 and PHQ ≥10, were compared with Pearson's Chi‐square, Fisher's Exact or Wilcoxon rank test, and Spearman's correlations. Results: In 117 PHQ <10 and 84 PHQ ≥10 patients, age differed (mean 59 vs 52 years; P = 0.001), and PHQ <10 had lower GAD‐7, ICSI‐PI, and OAB‐q scores at baseline ( P < 0.0001, P = 0.0003, and P < 0.0008, respectively). Implantation rates were similar between groups. Reoperation and complication rates within the first 6 months did not differ, similar proportions (majority) were improved on the GRA at each time point, and ICSI‐PI and OAB‐q scores improved significantly. PHQ scores only improved significantly for those with baseline PHQ ≥10. Baseline PHQ strongly correlated with GAD‐7 at baseline and 6 months, and baseline ICSI‐PI. Change in PHQ positively correlated with the change in GAD‐7, 6 month ICSI‐PI, and change in ICSI‐PI from baseline to 6 months. Conclusions: Coexisting depressive symptoms do not limit the efficacy of neuromodulation and PHQ improvements correlate with improved anxiety and bladder symptoms.