Quality of life in major depressive disorder before/after multiple steps of treatment and one-year follow-up.by IsHak WW, Mirocha J, James D, Tobia G, Vilhauer J, Fakhry H, Pi S, Hanson E, Nashawati R, Peselow ED, Cohen RM.Acta Psychiatrica Scandanavia. 2015 131:51-60.
OBJECTIVE: This study examines the impact of major depressive disorder [MDD] and its treatment on quality of life [QOL].METHOD: From the Sequenced Treatment Alternatives to Relieve Depression [STAR*D] trial, we analyzed complete data of 2280 adult MDD out-patients at entry/exit of each level of antidepressant treatments and after 12 months of entry to follow-up. QOL was measured using the QOL Enjoyment and Satisfaction Questionnaire [Q-LES-Q]. The proportions of patients scoring ‘within-normal’ QOL [within 10% of Q-LES-Q community norms] and those with ‘severely impaired’ QOL [>2 SD below Q-LES-Q community norms] were analyzed.RESULTS: Before treatment, no more than 3% of MDD patients experienced ‘within-normal’ QOL. Following treatment, statistically significant improvements were detected; however, the proportion of patients achieving ‘within-normal’ QOL did not exceed 30%, with >50% of patients experiencing ‘severely impaired’ QOL. Although remitted patients had greater improvements compared with non-remitters, 32-60% continued to experience reduced QOL. 12-month follow-up data revealed that the proportion of patients experiencing ‘within-normal’ QOL show a statistically significant decrease in non-remitters.CONCLUSION: Symptom-focused treatments of MDD may leave a misleading impression that patients have recovered when, in fact, they may be experiencing ongoing QOL deficits. These findings point to the need for investigating specific interventions to ameliorate QOL in MDD.
To conclude, the present analysis highlights the major pitfalls associated with MDD treatments that are purely symptom-focused. Such treatments can give the misleading impression that a patient has recovered, when in fact the patient continues to experience ongoing deficits in QOL. QOL did not improve further after the acute treatment phase even in remitters, and non-remitters showed a statistically significant decline at follow-up after one year. Consequently, clinicians and researchers need to move beyond the mere assessment of symptoms when treating and/or researching MDD, by incorporating QOL measurement, and by investigating specific and personalized interventions to ameliorate QOL.