Distinguishing Functional From Syndromal Recovery: Implications for Clinical Care and Research

Rush, A. John

doi:10.4088/jcp.15com09859

Cited by 19 publications

(11 citation statements)

References 11 publications

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“…The importance of psychosocial function in patient care is highlighted by evidence that psychosocial impairments often persist after symptomatic remission [18], are associated with worse long-term clinical outcomes [19–21], and remain a major concern for patients [22]. Functional recovery is distinct from symptomatic recovery and likely requires different treatment approaches [23, 24]. …”

Section: Introductionmentioning

confidence: 99%

Early Improvement in Psychosocial Function Predicts Longer-Term Symptomatic Remission in Depressed Patients

et al. 2016

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The goal of this study was to evaluate the relationship between early change in psychosocial function independent of depression severity and longer-term symptomatic remission. Participants of Combining Medications to Enhance Depression Outcomes trial were randomly selected for model selection (n = 334) and validation (n = 331). Changes in psychosocial function (Work and Social Adjustment Scale, WSAS) from baseline to week 6 were assessed and two data-driven sub-groups of WSAS change were identified in the randomly selected model selection half. Results of analyses to predict symptomatic remission at 3 and 7 months were validated for these sub-groups in the second half (validation sample). From baseline to week 6, psychosocial function improved significantly even after adjusting for depression severity at each visit and select baseline variables (age, gender, race, ethnicity, education, income, employment, depression onset before age 18, anxious features, and suicidal ideation), treatment-arm, and WSAS score. The WSAS change patterns identified two (early improvement and gradual change) subgroups. After adjusting for baseline variables and remission status at week 6, participants with early improvement in the second half (validation sample) had greater remission rates than those with gradual change at both 3 (3.3 times) and 7 months (2.3 times) following acute treatment initiation. In conclusion, early improvement in psychosocial function provides a clinically meaningful prediction of longer-term symptomatic remission, independent of depression symptom severity.

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Section: Introductionmentioning

confidence: 99%

Early Improvement in Psychosocial Function Predicts Longer-Term Symptomatic Remission in Depressed Patients

et al. 2016

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“…At best, only two thirds of patients respond (show at least a 50% drop in symptoms), and only about a third remit (show a complete normalization of symptoms; Cuijpers et al, 2014; Rush, Kraemer, et al, 2006). Functional impairment often lags behind symptomatic improvements (Rush, 2015; Sheehan et al, 2011; Sheehan, Nakagome, Asami, Pappadopulos, & Boucher, 2017). Of those who no longer meet diagnostic criteria for MDD at the end of treatment, over half will relapse within 2 years even if continued on maintenance antidepressant medication (Anderson et al, 2008; Cuijpers, van Straten, Andersson, & van Oppen, 2008; Rush, Trivedi, et al, 2006; Vittengl, Clark, Dunn, & Jarrett, 2007).…”

mentioning

confidence: 99%

Changes in Positive and Negative Affect During Pharmacological Treatment and Cognitive Therapy for Major Depressive Disorder: A Secondary Analysis of Two Randomized Controlled Trials

Dunn

German

Khazanov

et al. 2019

Clinical Psychological Science

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The cardinal symptoms of major depressive disorder (MDD) are heightened depressed mood (negative affectivity, or NA) and diminished interest or pleasure (positive affectivity, or PA). It is unknown how well treatments for MDD repair either symptom. Two secondary analyses of randomized controlled trials were therefore conducted. In Study 1, 180 adult outpatients with MDD received 16 weeks of antidepressant medication (ADM; n = 120) or cognitive therapy (CT; n = 60). In Study 2, adult outpatients with MDD were treated until remission with ADM ( n = 225) or ADM and CT ( n = 227). Across trials and treatments, intake disturbances were more marked in PA than NA, there was smaller repair of PA than NA during treatment, and disturbances remained more pronounced for PA than NA after treatment. Greater change in PA and NA were independently associated with depression symptom change. These findings suggest that depression treatments more effectively repair NA than PA and that outcomes may be improved with more effective targeting of the latter.

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“…Full functional recovery is the ultimate goal of MDD treatment, 13,14 with functional remission being defined as SDS subscale scores ≤ 2; 19 for this particular analysis, we used a shift to mild/no impairment (≤3) as the endpoint given the low rates of functional remission at the end of an 8-week trial 23 and the de-synchronicity between symptomatic remission and functional recovery. [9][10][11] A receiver operating characteristic (ROC) analysis was conducted to determine the optimal threshold of early improvement (percentage change from baseline in the SDS subscale score) for predicting achievement of the functional shift threshold for each respective subscale. First, changes in functioning over time were examined in patients included in the ROC analysis (patients with marked/extreme impairment (≥7) at baseline).…”

Section: Discussionmentioning

confidence: 99%

“…6 Functional impairment in patients with MDD seems to improve with treatment along with reduction in depressive symptoms. 7,8 However, functional recovery may lag behind symptomatic remission, [9][10][11] and residual symptoms of depression can delay full functional recovery even in patients who have achieved clinical remission. 12 Treatment goals for patients with MDD, therefore, should include both symptom remission and functional recovery.…”

Section: Introductionmentioning

confidence: 99%

Categorical improvement in functional impairment in depressed patients treated with desvenlafaxine

2017

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Objective. This post-hoc pooled analysis evaluated categorical change in functional impairment in patients with major depressive disorder (MDD) treated with desvenlafaxine versus placebo and examined whether early improvement in functioning predicted functional outcomes at study endpoint.Methods. Data were pooled from eight randomized, double-blind, placebo-controlled studies of desvenlafaxine for the treatment of MDD, including adults who were randomly assigned to receive desvenlafaxine 50 or 100 mg/d or placebo (N = 3,384). Shift tables were generated for categorical changes in functional impairment from baseline based on Sheehan Disability Scale (SDS) subscale scores. The categories were none/mild (0-3), moderate (4-6), and marked/ extreme (7-10). Treatment comparisons for prespecified shifts of interest and predictive value of week 2 or 4 improvement in SDS subscale scores for functional outcome at week 8 were assessed using logistic regression.

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Distinguishing Functional From Syndromal Recovery: Implications for Clinical Care and Research

Cited by 19 publications

References 11 publications

Early Improvement in Psychosocial Function Predicts Longer-Term Symptomatic Remission in Depressed Patients

Early Improvement in Psychosocial Function Predicts Longer-Term Symptomatic Remission in Depressed Patients

Changes in Positive and Negative Affect During Pharmacological Treatment and Cognitive Therapy for Major Depressive Disorder: A Secondary Analysis of Two Randomized Controlled Trials

Categorical improvement in functional impairment in depressed patients treated with desvenlafaxine

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