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

Abstract

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.

Daily activity level improvement with antidepressant medications predicts long-term clinical outcomes in outpatients with major depressive disorder

“… 14 Improvement with antidepressant treatment is not just restricted to change in depression severity. 15 – 17 In a previous report of employed MDD patients, we have found that work productivity is significantly impaired, improves early with treatment independent of depression severity, and is associated with better longer term outcomes. 18 However, this assessment of work productivity improvement is restricted to those who are employed.…”

“…Impairments due to depression affect multiple facets of life, including work productivity,5,6 social functions,7,8 sexual satisfaction,9 life satisfaction,10,11 interpersonal function,12 quality of life,13 and overall health 14. Improvement with antidepressant treatment is not just restricted to change in depression severity 15–17. In a previous report of employed MDD patients, we have found that work productivity is significantly impaired, improves early with treatment independent of depression severity, and is associated with better longer term outcomes 18.…”

Prediction of Acute-Phase Treatment Outcomes by Adding a Single-Item Measure of Activity Impairment to Symptom Measurement: Development and Validation of an Interactive Calculator from the STAR*D and CO-MED Trials

“…The finding that activity impairment improves with antidepressant treatment is consistent with findings reported previously in the CO-MED trial and by Lam et al (Lam et al, 2014; Jha et al, 2017). Previous reports have also found that persistent functional impairment after 6 weeks of antidepressant treatment was associated with poorer outcomes at 3 and 7 months when the same treatment was continued (Jha et al, 2016a, 2016c, 2017). Additionally, self-reported activity impairment (sixth item of WPAI) moderately correlates with the activity-interest dimension of depression severity (Uher et al, 2012) with <15% shared variance, suggesting these 2 are measuring different constructs of impairment associated with depression.…”

Spotlight on Pimavanserin Tartrate and Its Therapeutic Potential in the Treatment of Major Depressive Disorder: The Evidence to Date

“…1,2 It is associated with impairments in multiple domains of life such as work productivity, social functions, day to day activities, and quality of life. [3][4][5][6] Commonly used antidepressants are often ineffective in patients with MDD; 7 thereby necessitating the use of augmentation/adjunctive agents such as atypical antipsychotics 8 and esketamine, 9 psychotherapy, and/or non-invasive brain stimulation. [10][11][12][13] Pimavanserin tartrate, hereafter referred to as pimavanserin, is one such drug that has been studied for improving depression and associated symptoms in patients with MDD who have responded inadequately to one or more courses of serotonergic antidepressant.…”