Do depressed patients on adjunctive atypical antipsychotics demonstrate a better quality of life compared to those on antidepressants only? (a comparative cross-sectional study of a nationally representative sample of the united states population) (original) (raw)
Related papers
International Journal of Clinical Practice
Aim: This study compared functioning and productivity in individuals meeting Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) diagnostic criteria for binge eating disorder (BED) to those without BED. Methods: A sample of US adults from the National Health and Wellness Survey completed an Internet survey in October 2013. In addition to BED diagnostic criteria, the survey assessed functional impairment and productivity, respectively, using the Sheehan Disability Scale (SDS) and Work Productivity and Activity Impairment (WPAI) questionnaire. Differences between BED and non-BED respondents were assessed using multivariate models controlling for factors, including age, sex and comorbidities. Results: Of 22 397 respondents, 344 were categorised as BED respondents and 20 437 as non-BED respondents. Compared with non-BED respondents, BED respondents exhibited significantly (all P<.001) greater functional impairment on the SDS, as measured by mean±SD total (14.04±9.46 vs 3.41±6.36), work/school (3.86±3.62 vs 1.01±2.21), social life/leisure activities (5.29±3.49 vs 1.22±2.33) and family life/home responsibilities (4.89±3.44 vs 1.18±2.26) scores. Adjusted odds ratios (95% CIs) indicated that BED respondents were more impaired than non-BED respondents on the work/school (4.24 [3.33-5.40]), social life/leisure activities (6.37 [4.97-8.15]) and family life/home responsibilities (5.76 [4.51-7.34]) domains of the SDS. On the WPAI, BED respondents reported significantly (all P<.001) higher percentages (mean±SD) of absenteeism (9.59%±19.97% vs 2.90%±12.95%), presenteeism (30.00%±31.64% vs 10.86%±20.07%), work productivity loss (33.19%±33.85% vs 12.60%±23.22%) and activity impairment (43.52%±34.36% vs 19.94%±27.22%) than non-BED respondents. Conclusions: The findings suggest individuals with BED experience considerable impairment in functioning and work productivity compared with individuals without BED. This is an open access article under the terms of the Creative Commons Attribution-NonCommercial License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited and is not used for commercial purposes.
American Journal of Psychiatry, 2013
The authors sought to identify baseline clinical and sociodemographic characteristics associated with work productivity in depressed outpatients and to assess the effect of treatment on work productivity. Method: Employed depressed outpatients 18-75 years old who completed the Work Productivity and Activity Impairment scale (N=1,928) were treated with citalopram (20-40 mg/day) in the Sequenced Treatment Alternatives to Relieve Depression study. For patients who did not remit after an initial adequate antidepressant trial (level 1), either a switch to sertraline, sustained-release bupropion, or extendedrelease venlafaxine or an augmentation with sustained-release bupropion or buspirone was provided (level 2). Participants' clinical and demographic characteristics and treatment outcomes were analyzed for associations with baseline work productivity and change in productivity over time.
Depression Research and Treatment, 2012
Background. Major depressive disorder (MDD) is associated with significant impairment in occupational functioning. This study sought to determine which depressive symptoms and medication side effects were perceived by patients with MDD to have the greatest interference on work functioning. Methods. 164 consecutive patients with MDD by DSM-IV criteria completed a standard assessment that included a self-rated questionnaire about the degree to which symptoms and side effects interfered with work functioning. Results. The symptoms perceived by patients as interfering most with work functioning were fatigue and low energy, insomnia, concentration and memory problems, anxiety, and irritability. The medication side effects rated as interfering most with work functioning were daytime sedation, insomnia, headache, and agitation/anxiety. There were no differences between men and women in symptoms or side effects that were perceived as interfering with work functioning. Limitations. This was a cross-sectional study; only subjective assessments of work functioning were obtained; the fact that patients were using varied medications acts as a potential confound. Conclusions. Specific depressive symptoms and medication side effects were perceived by patients as interfering more with occupational functioning than others. These factors should be considered in treatment selection (e.g., in the choice of antidepressant) in working patients with MDD.
Efficacy of Vortioxetine on Cognitive Functioning in Working Patients With Major Depressive Disorder
The Journal of clinical psychiatry, 2016
This post hoc analysis investigates the effect of vortioxetine on cognitive functioning and depressive symptoms in working adults with major depressive disorder (MDD). Population data from FOCUS, a double-blind, randomized, placebo-controlled study investigating the efficacy of vortioxetine versus placebo on cognitive functioning and depression in patients with MDD, were used to analyze mean change from baseline scores for the Digit Symbol Substitution Test (DSST), Trail Making Test A/B (TMT-A/B), Stroop, and Perceived Deficits Questionnaire (PDQ). FOCUS, conducted from December 2011 through May 2013, included adult patients with recurrent MDD according to DSM-IV-TR criteria. Change in depression severity (Montgomery-Asberg Depression Rating Scale [MADRS] total score) was analyzed using data from 3 additional short-term placebo-controlled studies (2 of which included duloxetine) and 1 relapse prevention study. Analyses were done according to patients' working status at baseline ...
BMC psychiatry, 2009
Background: The prevalence of major depressive disorder (MDD) is highest in working age people and depression causes significant impairment in occupational functioning. Work productivity and work absence should be incorporated into clinical assessments but currently available scales may not be optimized for clinical use. This study seeks to validate the Lam Employment Absence and Productivity Scale (LEAPS), a 10-item self-report questionnaire that takes 3-5 minutes to complete.
Depression Severity and Effect of Antidepressant Medications. Authors' reply
Jama the Journal of the American Medical Association, 2010
In their meta-analysis, Mr Fournier and colleagues 1 drew the important conclusion that antidepressant medication, compared with placebo, is effective for very severely depressed patients but not for those who are less severely depressed. The authors stated that "evidence concerning the effects of [antidepressant medication] in patients with mild to moderate MDD [major depressive disorder] has been sparse." They did not state that the 1995 study by Elkin et al 2 not only reported a significant effect for imipramine for more severely depressed patients (in this case, a Hamilton Depression Rating Scale 3 [HDRS] score Ն20), but also reported the lack of a significant difference between imipramine and placebo for those who were less severely depressed (HDRS Ͻ20). This omission is of particular concern because the data in the study by Elkin et al are used as one of the data sets in the study by Fournier et al. Thus, the effect the authors were hypothesizing had already been reported for 1 of the 6 data sets in their mega-analysis. The authors also suggested that "[f]uture efforts might use alternative symptom measures to examine the effects of baseline severity on treatment outcome." In the study by Elkin et al, significant effects were found for the more severe patients using the Global Assessment Scale 4 as the pretreatment severity measure. This measure includes impairment of functioning, as well as severity of depressive symptoms. In addition, the use of the self-report Beck Depression Inventory 5 as the measure of both initial severity and outcome produced results similar to those for the HDRS. The results with these measures of pretreatment severity support the conclusion that imipramine is not significantly superior to placebo for less severely depressed patients. However, this finding does not necessarily lead to the conclusion that these patients could not benefit from other, particularly nonpharmacological, treatments.
Health and Quality of Life Outcomes, 2012
Background Use of atypical antipsychotics (AA) in combination with an antidepressant is recommended as an augmentation strategy for patients with depression. However, there is a paucity of data comparing aripiprazole and other AAs in terms of patient reported outcomes. Therefore, the objective of this study was to examine the levels of HRQoL and health utility scores in patients with depression using aripiprazole compared with patients using olanzapine, quetiapine, risperidone and ziprasidone. Methods Data were obtained from the 2009, 2010, and 2011 National Health and Wellness Survey (NHWS), a cross-sectional, internet-based survey that is representative of the adult US population. Only those patients who reported being diagnosed with depression and taking an antidepressant and an atypical antipsychotic for depression were included. Patients taking an atypical antipsychotic for less than 2 months or who reported being diagnosed with bipolar disorder or schizophrenia were excluded. ...
Reply to "Comparing the Efficacy and Safety of Fluoxetine and Venlafaxine in Outpatient Depression
The Journal of Clinical Psychiatry, 1999
Sir: Your recent publication (JCP Visuals, January 1999 1) unfairly characterizes some atypical antipsychotics as more likely to produce weight gain than risperidone. Weight gain is a side effect of the atypicals, but our work with olanzapine, clozapine, and risperidone demonstrates that a patient's diet is a better predictor of weight gain than a physician's selection of a particular atypical antipsychotic medication. Contrary to the view expressed in JCP Visuals-that weight gain is unmanageable-our work tells quite the opposite story. With nutritional counseling and dietary changes, patients in our study who gained weight were able to shed that weight and keep it off. 2 This was true for each drug and contradicts JCP Visuals, which infers that once weight is added (my receptors made me eat it!), it never comes off. Having followed the individuals in our study for 2 years, we conclude that while symptoms and medications can complicate the process of weight management, the critical variables are more likely to be healthy eating habits and dietary education. Interestingly, prior to starting atypical medications in our study, patients who were apathetic, with little or no motivation to attend programs or work outside the residence, gained the most weight. We attribute the atypicals' efficacy in treating negative symptoms to successful weight management in these patients. As evidence continues to mount that atypicals can lead to higher productivity 3 and greater self-sufficiency, we regard the JCP Visuals publication on weight gain to be misleading and an impediment to greater prescription of these newer agents.