The Effects of Newer Antidepressants on Occupational Impairment in Major Depressive Disorder: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

Abstract

Our meta-analysis suggests that newer antidepressants have a small, positive impact on occupational impairment in the short-term, but the clinical significance of this impact is questionable. To improve assessment of this important outcome, future research studies should use more comprehensive measures of occupational functioning, productivity and impairment, and longer treatment durations.

Trajectories of Function and Symptom Change in Desvenlafaxine Clinical Trials

“…Similar patterns and degrees of change were seen for trajectories of functioning with placebo, where a 12.8-point difference (13.6 to 0.8) was seen between most and least favorable SDS trajectories, again excluding the low baseline SDS trajectory. Collectively, these finding shed new light on previous meta-analyses reporting the limited effect that ADMs have on functional improvement, vis-à-vis placebo 31,32 . Our observations suggest patients who showed little or no functional improvement with desvenlafaxine belonged to 1 of 2 trajectories: (1) patients for whom desvenlafaxine did not significantly reduce symptoms; and (2) patients with a high level of functioning at treatment onset.…”

The impact of employment on cognition and cognitive reserve: implications across diseases and aging

“…Depression has been linked to unemployment and productivity loss. 30, 31 Lerner et al advanced several mechanisms that may be responsible for such adverse job-related outcomes among depressed persons; these include poor job performance, discrimination, difficulty …”

“…30 Although treatment for depression is generally associated with improved work outcomes, including gains in productivity, specific treatments for depression-related cognitive impairment that can optimize occupational functioning are needed. 31,60,61 Cognitive impairments that result from diseases can be managed using nonpharmacological strategies, such as remediation techniques, compensatory strategies, and adaptive approaches, which may facilitate employment reintegration. For example, Elgamal et al conducted a study to assess the effects of a 10-week course of computer-based cognitive remediation with depressed patients.…”

“…35,36 Measurable impairments have been found in speed of processing, sustained and selective attention, learning and memory, and executive function. 31 Such cognitive impairment can be disruptive to occupational functioning. When Lam et al examined how symptoms interfered with occupational functioning among employed adults with major depression, their findings indicated that problems with concentration and memory were the major culprits.…”

“…37 Associations between cognitive impairment and poorer occupational outcomes were found in a systematic review of studies that explored the relationship between objectively measured cognitive impairments and occupational functioning in people with major depression. 31 Coupled with the effect of depression on employment, the reduction in employment or possible declines in the complexity of job duties may further create a negative neuroplastic response, which over time can compromise cognitive reserve and cognitive functioning.…”