Predictors of functional improvement in employed adults with major depressive disorder treated with desvenlafaxine

Abstract

We carried out a secondary analysis of a double-blind, placebo-controlled trial of desvenlafaxine for major depressive disorder (MDD) to explore the associations between depressive symptoms and subtypes, and functional outcomes, including work functioning. Employed outpatients with MDD were assigned randomly in a 2 : 1 ratio to receive desvenlafaxine 50 mg/day or placebo for 12 weeks. Analyses were carried out post-hoc with the intent-to-treat (ITT) sample (N=427) and a prospectively defined modified ITT sample (N=310), composed of patients with baseline 17-item Hamilton Rating Scale for Depression score of at least 20. Functional outcomes at week 12 included items and factors from the Montgomery-Åsberg Depression Rating Scale, Sheehan Disability Scale, and the Work Productivity and Activity Impairment questionnaire. In the modified ITT sample, but not in the ITT sample, desvenlafaxine-treated patients showed significantly greater improvement in several functional outcomes in the responder, nonanxious, and normal-energy patient subgroups. Improvement in the 17-item Hamilton Rating Scale for Depression total score at week 2 predicted change at week 12 in several functional outcomes. Functional improvement at 12 weeks was greater in subgroups of patients and was also significantly predicted by early improvement in depressive symptoms in employed patients with MDD treated with desvenlafaxine.

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

“…Our findings of improvement in activity impairment with treatment are consistent with those previously reported by Lam et al22 The strength of correlation between levels of depression severity and activity impairment in our report (correlation coefficient =0.54 and 0.57 during acute and continuation phases, respectively) are also comparable to those reported by Lam et al22 (correlation coefficient between activity impairment and HRSD17 =0.56). Previous studies have reported that depressed patients place greater importance to improvement in functioning as compared to reduction in depression severity 44,45.…”

“…Antidepressant treatment results in reduced activity impairment 22. However, the clinical significance of these improvements is unclear.…”

“…In contrast to the consensus guidelines to evaluate change in depression severity with treatment,23 there are no similar easy-to-interpret recommendations for measuring or con-ceptualizing changes in activity impairment. While antidepressant medications are superior to placebo,22 whether individual medications or their combinations differentially improve activity impairment is unclear. Similarly, while reduced depression severity is associated with improvement in activity impairment,22 the relationship of activity impairment with other aspects of functioning as well as treatment-emergent side effects in depressed patients continues to be unknown.…”

“…While antidepressant medications are superior to placebo,22 whether individual medications or their combinations differentially improve activity impairment is unclear. Similarly, while reduced depression severity is associated with improvement in activity impairment,22 the relationship of activity impairment with other aspects of functioning as well as treatment-emergent side effects in depressed patients continues to be unknown.…”

Population Pharmacokinetics of Desvenlafaxine: Pharmacokinetics in Korean Versus US Populations

“…It has established efficacy over placebo at the approved doses of 50 mg/d and 100 mg/d in multiple clinical trials, and its efficacy has been demonstrated across age and sex subgroups and in patients with metabolic syndrome or anxious or severe depression at baseline in pooled post hoc analyses . Treatment with desvenlafaxine has also been shown to improve functional outcomes and quality‐of‐life measures compared with placebo in clinical trial patients …”