Abstract
BackgroundThe degrees to which residual symptoms in major depressive disorder (MDD) adversely affect patient functioning is not known. This post-hoc analysis explored the association between different residual symptoms and patient functioning.MethodsPatients with MDD who responded (≥50% on the 17-item Hamilton Rating Scale for Depression; HAMD-17) after 3 months of treatment (624/930) were included. Residual core mood-symptoms (HAMD-17 core symptom subscale ≥1), residual insomnia-symptoms (HAMD-17 sleep subscale ≥1), residual anxiety-symptoms (HAMD-17-anxiety subscale ≥1), residual somatic-symptoms (HAMD-17 Item 13 ≥1), pain (Visual Analogue Scale ≥30), and functioning were assessed after 3 months treatment. A stepwise logistic regression model with normal functioning (Social and Occupational Functioning Assessment Scale ≥80) as the dependent variable was used.ResultsAfter 3 months, 59.5% of patients (371/624) achieved normal functioning and 66.0% (412/624) were in remission. Residual symptom prevalence was: core mood symptoms 72%; insomnia 63%; anxiety 78%; and somatic symptoms 41%. Pain reported in 18%. Factors associated with normal functioning were absence of core mood symptoms (odds ratio [OR] 8.7; 95% confidence interval [CI], 4.6–16.7), absence of insomnia symptoms (OR 1.8; 95% CI, 1.2–2.7), episode length (4–24 weeks vs. ≥24 weeks [OR 2.0; 95% CI, 1.1–3.6]) and better baseline functioning (OR 1.0; 95% CI, 1.0–1.1). A significant interaction between residual anxiety symptoms and pain was found (p = 0.0080).ConclusionsDifferent residual symptoms are associated to different degrees with patient functioning. To achieve normal functioning, specific residual symptoms domains might be targeted for treatment.
Highlights
The degrees to which residual symptoms in major depressive disorder (MDD) adversely affect patient functioning is not known
Residual symptom prevalence After 3 months of acute antidepressant treatment, the most frequent residual symptom was anxiety in 78.2% of patients, followed by core mood symptoms in 72.1%, residual insomnia in 63.0% and somatic symptoms in 41.3%
Factors associated with normal functioning were absence of core mood symptoms, absence of insomnia symptoms, shorter episode length (4–24 weeks vs. ≥24 weeks [odds ratios (OR) 2.0; 95% confidence intervals (CI), 1.1–3.6]) and better baseline functioning
Summary
The degrees to which residual symptoms in major depressive disorder (MDD) adversely affect patient functioning is not known. A few studies have evaluated the impact of residual symptoms on functional impairment [1,2,7,8], to our knowledge, no published studies have examined the specific role of each residual symptom domain on functional impairment This is definitely an area worthy of investigation, since the aim of treating depression is to achieve clinical remission, and to return the patient to previous levels of functioning [9]. Knowledge of which residual symptom domains are associated with significant functional impairment and, to what degree would assist physicians in the implementation of specific strategies and treatments to increase the chances of achieving normal or previous levels of functioning
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