Treatment and Evaluation of the Effectiveness

After laboratory testing, patients were randomly prescribed sertraline or venlafaxine. All 156 patients were initially treated for 1–2 weeks with sertraline at 25 mg/day or venlafaxine at 37.5 mg/day, then increased to the intermediate dose for Japanese (sertraline: 50 mg/day; venlafaxine: 75 mg/day) in a stepwise manner.^15,16 Twenty-four patients (15.4%) declined to continue treatment, mainly due to complaints of side effects within 2 weeks although the medicine was at the minimum dose. They were excluded from this study. Twenty patients who complained of side effects were able to prolong treatment by switching to venlafaxine or sertraline. The final number of participants was 132. The effectiveness of treatment was determined by subjective reports from the patient of improved physical symptoms continuing ≥4 weeks (“Yes or No”) after 8–16 weeks of treatment. When such improvement was “Yes”, 3HB was measured at that time. If a patient did not manifest improvement after 8 weeks and expressed a desire to end medication, 3HB was measured at that time. When patients expressed a desire to continue treatment even without improvement after 16 weeks, 3HB was measured in week 16. The mean interval to 3HB measurement was 85.7 days (range, 56–112 days) from the beginning of treatment, with means of 77.6 days for patients with improvement and 99.4 days for patients without improvement. A total of 105 patients (79.5%) with or without improvement continued on the same treatment for ≥16 weeks depending on patient preference. The remaining 27 patients (20.5%) without improvement desired different treatments or a referral to another hospital.