Efficacy of antidepressants on measures of workplace functioning in major depressive disorder: A systematic review

Lee, Yena; Rosenblat, Joshua D.; Lee, JungGoo; Carmona, Nicole E.; Subramaniapillai, Mehala; Shekotikhina, Margarita; Mansur, Rodrigo B.; Brietzke, Elisa; Lee, Jae-Hon; Ho, Roger; Yim, Samantha J.; McIntyre, Roger S.

doi:10.1016/j.jad.2017.11.003

Cited by 95 publications

(59 citation statements)

References 59 publications

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“…This study included the SDS as a key secondary endpoint to assess functional disability, and improvement in workplace function has been demonstrated with antidepressant therapy in patients with MDD. 41 The SDS is well validated and widely accepted for assessing functional outcomes in patients with MDD. 42 In a systematic review of studies that assessed functional outcomes, the authors suggested that improvements in function (SDS) should be considered for inclusion as co-endpoints with symptomatic assessments when evaluating treatments for MDD.…”

Section: Discussionmentioning

confidence: 99%

A Phase 2, Randomized, Double-Blind, Placebo-Controlled Study of Adjunctive Pimavanserin in Patients With Major Depressive Disorder and an Inadequate Response to Therapy (CLARITY)

Fava¹,

Dirks²,

Freeman³

et al. 2019

J. Clin. Psychiatry

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Objective: Pimavanserin is a 5-hydroxytryptamine-2A antagonist and inverse receptor agonist. This phase 2 study examined the efficacy and safety of pimavanserin as adjunctive therapy in patients with major depressive disorder (MDD). Methods: This was a multicenter, randomized, double-blind, placebo-controlled study in patients with DSM-5-defined MDD and an inadequate response to a selective serotonin reuptake inhibitor (SSRI) or serotonin-norepinephrine reuptake inhibitor (SNRI). Using a 2-stage sequential parallel-comparison design, patients were initially randomized in a 3:1 ratio to placebo or pimavanserin added to ongoing SSRI or SNRI therapy; at 5 weeks, placebo nonresponders were re-randomized to placebo or pimavanserin for an additional 5 weeks. Key endpoints were change from baseline to the end of each stage in 17-item Hamilton Depression Rating Scale (HDRS-17) total score and Sheehan Disability Scale (SDS) score. Results: Between December 2016 and October 2018, 207 patients were randomized. For the prespecified pooled Sequential Parallel Comparison Design analyses of Stages 1 and 2, the least squares (LS) mean (SE) difference for the HDRS-17 total score was −1.7 (0.85) (P = .039) and for the SDS score was −0.8 (0.29) (P = .004). At week 5 of Stage 1, LS mean (SE) difference for pimavanserin versus placebo was significant for changes on the HDRS-17 (−4.0 [1.09], P = .0003) and SDS (−1.2 [0.40], P = .0036) with effect sizes of 0.626 and 0.498, respectively. Early and sustained separation of pimavanserin from placebo (P < .05) occurred at 1 week. The most common adverse events with pimavanserin were dry mouth, nausea, and headache. Conclusions: Pimavanserin demonstrated robust efficacy in patients with MDD and an inadequate response to an SSRI or SNRI. Tolerability was consistent with previous experience. Trial Registration: ClinicalTrials.gov identifier: NCT03018340 J Clin Psychiatry 2019;80(6):19m12928 To cite: Fava M, Dirks B, Freeman MP, et al. A phase 2, randomized, doubleblind, placebo-controlled study of adjunctive pimavanserin in patients with major depressive disorder and an inadequate response to therapy (CLARITY).

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Section: Discussionmentioning

confidence: 99%

A Phase 2, Randomized, Double-Blind, Placebo-Controlled Study of Adjunctive Pimavanserin in Patients With Major Depressive Disorder and an Inadequate Response to Therapy (CLARITY)

Fava¹,

Dirks²,

Freeman³

et al. 2019

J. Clin. Psychiatry

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“…Selected studies have involved clinical trials or systematic reviews Lee 35 (A) conducted a systematic review published in 2018 of clinical trials that examined the impact of pharmacological treatment of depression on occupational outcomes such as work functionality and absenteeism. The selected papers met the selection criteria defined: adult population with major depression, submitted to pharmacological intervention with antidepressants, in randomized, double-blind, placebo or comparative intervention clinical trials with outcomes of work functionality or absenteeism assessed quantitatively with standardized instruments.…”

Section: Screening Of Depression In Workers Associated To Treatmentmentioning

confidence: 99%

Depression in the workplace: screening and treatment

Neto

Myung

Murta

et al. 2019

Rev. Assoc. Med. Bras.

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The Guidelines Project, an initiative of the Brazilian Medical Association, aims to combine information from the medical field in order to standardize producers to assist the reasoning and decision-making of doctors. The information provided through this project must be assessed and criticized by the physician responsible for the conduct that will be adopted, depending on the conditions and the clinical status of each patient.Screening depression in the occupational setting has the potential of diagnosing workers with depression symptoms in different levels of severity. Depression and its treatment have the potential of modifying occupational outcomes of functionality, productivity, absenteeism, presenteeism, return to work, work engagement, unemployment, among others. It was carried out from the systematic review of literature in the medline database, recovering 21,232 papers, 54 (figure 1 -annex I) being selected to answer the clinical questions: is it necessary to screen workers for depression? And is treatment effective and safe? The details of the methodology and the results of this guideline are exposed in annex I. KEY POINTSScreening depression in the occupational setting has the potential to diagnose, in impactful prevalence and with acceptable accuracy, workers with symp-

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“…8 Epidemiological and clinical studies provide results that are in accordance with the assertion that cognitive deficits (self-rated, objectively measured) account for more variability in interpersonal adjustments and/or workplace performance (i.e., absenteeism, presenteeism) than total depression symptom severity and/or other domains (i.e., factors) in persons with mood disorders. [9][10][11][12] It is additionally noted that cognitive deficits in MDD may predate the onset of "mood symptoms" in MDD and may progress in overall magnitude of deficits as a function of episode frequency/illness duration. 13,14 Notwithstanding the availability of multiple modalities of antidepressant treatment, relatively few studies in psychiatry have primarily sought to determine whether improving cognitive function in MDD improves PROs and/ or is cost effective.…”

Section: Introductionmentioning

confidence: 99%

“…13,14 Notwithstanding the availability of multiple modalities of antidepressant treatment, relatively few studies in psychiatry have primarily sought to determine whether improving cognitive function in MDD improves PROs and/ or is cost effective. 10,15 The mediational relevance of cognition in MDD potentially extrapolates to all NPDs, indicating that screening for, measuring, preventing, and treating cognitive deficits in psychiatry is not only a primary therapeutic target, but also should be conceptualized as a transdiagnostic domain to be considered regardless of patient age and/or differential diagnosis. 16,17…”

Section: Introductionmentioning

confidence: 99%

Expert Consensus on Screening and Assessment of Cognition in Psychiatry

et al. 2019

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During the past two decades, it has been amply documented that neuropsychiatric disorders (NPDs) disproportionately account for burden of illness attributable to chronic non-communicable medical disorders globally. It is also likely that human capital costs attributable to NPDs will disproportionately increase as a consequence of population aging and beneficial risk factor modification of other common and chronic medical disorders (e.g., cardiovascular disease). Notwithstanding the availability of multiple modalities of antidepressant treatment, relatively few studies in psychiatry have primarily sought to determine whether improving cognitive function in MDD improves patient reported outcomes (PROs) and/or is cost effective. The mediational relevance of cognition in MDD potentially extrapolates to all NPDs, indicating that screening for, measuring, preventing, and treating cognitive deficits in psychiatry is not only a primary therapeutic target, but also should be conceptualized as a transdiagnostic domain to be considered regardless of patient age and/or differential diagnosis.

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Efficacy of antidepressants on measures of workplace functioning in major depressive disorder: A systematic review

Cited by 95 publications

References 59 publications

A Phase 2, Randomized, Double-Blind, Placebo-Controlled Study of Adjunctive Pimavanserin in Patients With Major Depressive Disorder and an Inadequate Response to Therapy (CLARITY)

A Phase 2, Randomized, Double-Blind, Placebo-Controlled Study of Adjunctive Pimavanserin in Patients With Major Depressive Disorder and an Inadequate Response to Therapy (CLARITY)

Depression in the workplace: screening and treatment

Expert Consensus on Screening and Assessment of Cognition in Psychiatry

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