Tuesday, August 16, 2016

Early Improvement in Work Productivity May Predict Treatment Success in Depression

Patients with depression who report robust improvement in work productivity in the first few weeks of treatment may be most likely to remain in remission several months later, according to a report in AJP in Advance. The findings highlight the potential value of including work productivity assessments as part of routine clinical practice when evaluating the effectiveness of antidepressant treatment.

Researchers from the departments of psychiatry and clinical sciences at the University of Texas Southwestern Medical Center, Dallas, and the National University of Singapore analyzed remission data from the Combining Medications to Enhance Depression Outcomes trial. This multisite, single-blind, randomized, controlled trial of outpatients with chronic and/or recurrent nonpsychotic depression compared the effectiveness of antidepressant monotherapy (escitalopram plus placebo) with combination therapies (buproprion plus escitalopram or venlafaxine plus mirtazapine). As part of the original trial, the researchers measured work productivity at baseline and at each study visit throughout the trial.

Analysis of these self-reports revealed three distinct trajectories of work productivity during the first six weeks of treatment: robust early improvement (24% of participants), minimal change (49% of participants), and high-impairment slight reduction (27% of participants). (Work productivity outcomes were similar for SSRI monotherapy and the buproprion and venlafaxine combinations, controlling for baseline severity; all work productivity outcomes significantly improved after 12 weeks of treatment.)

Compared with other patients, patients who had “robust early improvement” had three to five times higher remission rates at three months and two to five times higher remission rates at seven months, even after the researchers controlled for select baseline variables and remission status at week six.

“We have ... demonstrated that early changes in work productivity are significant predictors of long-term clinical course,” the researchers wrote. “These findings highlight the multidimensional improvement with antidepressant treatment and argue for inclusion of work productivity assessments in routine clinical practice.”

For related information, see the Psychiatric News article "Mental Health in Workplace Integral to Business Success, CEOs Say.”

(Image: iStock/Yuri_Arcurs)


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