Factors Associated With Health-Related Quality of Life Among Outpatients With Major Depressive Disorder

Trivedi, Madhukar H.; Rush, A. John; Wisniewski, Stephen R.; Warden, Diane; McKinney, William T.; Downing, Michael; Berman, Susan R.; Farabaugh, Amy; Luther, James F.; Nierenberg, Andrew A.; Callan, Judith A.; Sackeïm, Harold A.

doi:10.4088/jcp.v67n0203

Cited by 144 publications

(112 citation statements)

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“…This increases our knowledge of the factors that affect the treatment response. These finding were also observed in a large cohort of out patients treated with selective serotonin reuptake inhibitors (SSRI) [25]. Furthermore, considering the highest ICD-derived subscore, depression prevailed in half of the cases, anxiety prevailed in 41.3% of the cases and somatic symptoms of anxiety/depression were highest in 8.5% of the patients.…”

Section: Discussionmentioning

confidence: 64%

A Hypericum Extract in the Treatment of Depressive Symptoms in Outpatients: An Open Study

Melzer

Brignoli²,

Keck³

et al. 2010

Forsch Komplementmed

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Background: Extracts of Hypericum perforatum have demonstrated in randomized trials (RCTs) to be effective in mild to moderate depressive episodes. However, as their use in daily practice may differ from that in RCTs we have conducted a study to achieve a better estimate of the range and frequency of adverse drug reactions (ADR) and the efficacy. Patients and Methods: In an observational study in Germany, adult outpatients with depressive syndrome were treated with an extract of St. John’s Wort. Study duration was 12 weeks, with control visits every 4 weeks. Besides anamnestic data, the variables assessed were: evolution of ICD-10 derived symptom score, Global Clinical Impression scale (GCI), and tolerability. Results: 1,778 patients from 304 centers participated in the study (mean duration of disorder 7.3 ± 18.9 months), and 1,541 patients completed it. At the last control visit the ICD-10 sum score had dropped by 63.1% and the proportion of patients described as ‘normal to mildly ill’ (GCI-s) had increased from 21.6% at admission to 72.4%. Regarding the GCI-i, 77% of the patients had improved ‘very much’ or ‘much’ at the last visit. This was consistent with their self-assessment (76%). Lower age and shorter duration of the disorder were associated with significantly better outcomes. The incidence of ADRs was 3.54% and had been decreasing continuously from the first control visit onwards; serious ADRs did not occure. Conclusions: The herbal drug was well tolerated, and no new or serious ADR were identified. In view of the limitations inherent to the study design, it can be concluded that extracts of St. John’s Wort are effective as an antidepressant in the management of depression in daily practice.

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Section: Discussionmentioning

confidence: 64%

A Hypericum Extract in the Treatment of Depressive Symptoms in Outpatients: An Open Study

Melzer

Brignoli²,

Keck³

et al. 2010

Forsch Komplementmed

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“…Other studies have identified risk factors including older age, poor health status, and low energy levels [56] and, from the STARÃD trial, unemployment, lower income, nonCaucasian race, male gender, less education, poorer functional status, and lower QOL. [74] Specific types of co-morbidity and types of depression symptoms are also important risk factors for partial or nonresponse. For example, pain, anxiety, and sleep problems have all been shown to be risk factors for poor response to treatment and improvement in these symptoms is associated with higher remission rates and lower relapse or recurrence rates.…”

Section: Discussionmentioning

confidence: 99%

“…Based on the available information about the factors that decrease the likelihood of remission, there are several possible actions that could be taken by government or private health-care decision makers to achieve higher rates of remission including comprehensive provider and patient education and development of patient monitoring and counseling strategies designed to increase adherence to treatment guidelines; target treatment education and management strategies to those at greater risk of not achieving remission such as those who have high levels of co-morbidity, are unemployed, less educated, and with poorer baseline functional status; create a quality of care Health Employer Data and Information Set measure that does not just measure duration of treatment and frequency of provider contacts, [81] but also tracks patient response over time similar to that used in the STARÃD trial [74] ; and develop alternative treatment regimens that will be more effective at achieving remission with first-line treatment. These might include combination treatment regimens with currently available drugs or the addition or substitution of new drugs for current treatment regimens.…”

Section: Discussionmentioning

confidence: 99%

Nonresponse, partial response, and failure to achieve remission: humanistic and cost burden in major depressive disorder

et al. 2009

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Objective: To characterize the spectrum of clinical outcomes achieved with depression treatment and the associated impact on quality of life (QOL), functional status, overall well-being, health-care costs, and productivity. Sources: Electronic databases including Medline were searched for English language sources between 1995 and 2007 using key words of depression, nonresponse, partial response, and remission and QOL, functional status, utility, cost, and productivity. Study selection: Relevant abstracts were obtained for 488 references and full-text articles were reviewed that included primary data and compared outcomes by treatment response. Data were abstracted from 26 full-text articles. Data abstraction: Detailed evidence tables were prepared with the relevant data as well as information on the study design. All data abstracted were checked for accuracy. Synthesis: Treatment remitters and partial responders reported clinically and statistically significant improvements in QOL, functional status, and overall well-being compared to nonresponders. Annual health-care costs and productivity losses were significantly lower for remitters and partial responders compared to nonresponders. Conclusions: The reduced disease burden for remitters and partial responders compared to nonresponders indicates that new treatment strategies that improve the rates of response/remission with initial treatment might have value to patients and to society. Depression and Anxiety 26:83-97, 2009.

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“…Traditional definitions of outcomes for depression only focus on symptomatic improvement or response, rather than full remission of symptoms and fail to emphasize the substantial impact of depression on social function (Rush et al, 2006b;Trivedi et al, 2006d;Wisniewski et al, 2006). There is considerable evidence that even with treatment, residual symptoms often persist, leading to psychosocial dysfunction (Bakish 2001;Judd et al, 1998;Trivedi et al, 2006d), and the longer a patient remains symptomatic, the lower the chances of a complete recovery (Keller et al, 1992). The co-occurrence of MDD and substance abuse or other comorbidities intensifies the degree of medical and psychosocial impairment, resulting in significant suffering and degradation in global function.…”

Section: Residual Symptoms and Functional Impairment In Major Depressionmentioning

confidence: 99%

Measurement-based care for refractory depression: A clinical decision support model for clinical research and practice

Trivedi

Daly

2007

Drug and Alcohol Dependence

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Despite years of antidepressant drug development and patient and provider education, suboptimal medication dosing and duration of exposure resulting in incomplete remission of symptoms remains the norm in the treatment of depression. Additionally, since no one treatment is effective for all patients, optimal implementation focusing on the measurement of symptoms, side effects, and function is essential to determine effective sequential treatment approaches. There is a need for a paradigm shift in how clinical decision making is incorporated into clinical practice and for a move away from the trial-and-error approach that currently determines the "next best" treatment. This paper describes how our experience with the Texas Medication Algorithm Project (TMAP) and the Sequenced Treatment Alternatives to Relieve Depression (STAR*D) trial has confirmed the need for easy-to-use clinical support systems to ensure fidelity to guidelines. To further enhance guideline fidelity, we have developed an electronic decision support system that provides critical feedback and guidance at the point of patient care. We believe that a measurement-based care (MBC) approach is essential to any decision support system, allowing physicians to individualize and adapt decisions about patient care based on symptom progress, tolerability of medication, and dose optimization. We also believe that successful integration of sequential algorithms with MBC into real-world clinics will facilitate change that will endure and improve patient outcomes. Although we use major depression to illustrate our approach, the issues addressed are applicable to other chronic psychiatric conditions including comorbid depression and substance use disorder as well as other medical illnesses.

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Factors Associated With Health-Related Quality of Life Among Outpatients With Major Depressive Disorder

Cited by 144 publications

References 0 publications

A Hypericum Extract in the Treatment of Depressive Symptoms in Outpatients: An Open Study

A Hypericum Extract in the Treatment of Depressive Symptoms in Outpatients: An Open Study

Nonresponse, partial response, and failure to achieve remission: humanistic and cost burden in major depressive disorder

Measurement-based care for refractory depression: A clinical decision support model for clinical research and practice

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