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When Depression Symptoms Remit, Quality of Life Improves — for Some

Summary and Comment |
July 18, 2014

When Depression Symptoms Remit, Quality of Life Improves — for Some

  1. Joel Yager, MD

Still, more than 30% of patients in pharmacologically induced remission reported below-normal quality of life, and 9% reported severe impairment.

  1. Joel Yager, MD

Depression treatment studies usually focus on achieving symptom remission (minimal or no symptoms) or response (symptom reduction of ≥50%); few also consider overall quality of life (QOL). Using data from 2280 patients entered into STAR*D, a large, multistep treatment study of major depression (NEJM JW Psychiatry Apr 5 2006), investigators examined how treatment affected patient-rated satisfaction or enjoyment of mood, relationships, living situations, and physical health). Less than 2% of participants had baseline QOL scores within the normal range.

Among 812 patients whose depression remitted in level 1 (citalopram monotherapy), 79% had severely impaired self-rated QOL at entry. At remission, QOL scores were normal in 68% and severely impaired in 9%. Among 193 remitters in a 1-year follow-up, QOL impairment was severe in 14% at start of follow-up and in 13% afterwards.

Level-1 nonremitters generally had lower QOL self-ratings when entering later treatment steps. Among level-1 nonremitters, 89% had severely impaired baseline QOL, which remained severely impaired in 73% at the end of level 1. Among 221 nonremitters in follow-up, QOL was severely impaired in 41% at the start but 68% at 12 months.

Comment

STAR*D was limited by self-report measures and lack of data on dropouts. Patients receiving level-1 treatment received no psychotherapy, and, paradoxically, adverse drug effects might have worsened QOL for some. Although the percentage of level-1 remitters with normal self-rated QOL approximates that found in community populations, substantial numbers of remitters (and, of course, patients with only response or no response) had inferior QOL. These findings strongly encourage clinicians to include a broad range of psychosocial interventions targeting quality-of-life domains in addition to symptom-focused pharmacological interventions for major depression.

  • Disclosures for Joel Yager, MD at time of publication Grant /Research support AHRQ Editorial boards Bulletin of the Menninger Clinic; Eating Disorders: Journal of Treatment and Prevention; Eating Disorders Review (Editor-in-Chief); International Journal of Eating Disorders; UpToDate; FOCUS: The Journal of Lifelong Learning in Psychiatry Leadership positions in professional societies American Psychiatric Association (Chair, Council of Quality Care)

Citation(s):

Reader Comments (2)

Judith Ronat M. D. Physician, Psychiatry, Private Practice in Kfar Saba, Israel

In ancient times, DSM and DSM 2, we differentiated between idiopathic depression and reactive depression. A pity we lost that differentiation! If someone is depressed as a reaction to something, and that something has not changed, is QOL will remain poor even if medicines have improved some of the symptoms.

George Howell MD Physician, Family Medicine/General Practice, Private practice

It takes more than pills to fully care for most patients!

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