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Increase in work productivity of depressed individuals with improvement in depressive symptom severity.

Publication ,  Journal Article
Trivedi, MH; Morris, DW; Wisniewski, SR; Lesser, I; Nierenberg, AA; Daly, E; Kurian, BT; Gaynes, BN; Balasubramani, GK; Rush, AJ
Published in: Am J Psychiatry
June 2013

OBJECTIVE: 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 extended-release 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. RESULTS: Education, baseline depression severity, and melancholic, atypical, and recurrent depression subtypes were all independently associated with lower benefit to work productivity domains. During level 1 treatment, work productivity in several domains improved with reductions in depressive symptom severity. However, these findings did not hold true for level 2 outcomes; there was no significant association between treatment response and reduction in work impairment. Results were largely confirmed when multiple imputations were employed to address missing data. During this additional analysis, an association was also observed between greater impairment in work productivity and higher levels of anxious depression. CONCLUSIONS: Patients with clinically significant reductions in symptom severity during initial treatment were more likely than nonresponders to experience significant improvements in work productivity. In contrast, patients who achieved symptom remission in second-step treatment continued to have impairment at work. Patients who have demonstrated some degree of treatment resistance are more prone to persistent impairment in occupational productivity, implying a need for additional, possibly novel, treatments.

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Published In

Am J Psychiatry

DOI

EISSN

1535-7228

Publication Date

June 2013

Volume

170

Issue

6

Start / End Page

633 / 641

Location

United States

Related Subject Headings

  • Young Adult
  • Work
  • Venlafaxine Hydrochloride
  • Treatment Outcome
  • Severity of Illness Index
  • Sertraline
  • Selective Serotonin Reuptake Inhibitors
  • Psychiatry
  • Psychiatric Status Rating Scales
  • Middle Aged
 

Citation

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Trivedi, M. H., Morris, D. W., Wisniewski, S. R., Lesser, I., Nierenberg, A. A., Daly, E., … Rush, A. J. (2013). Increase in work productivity of depressed individuals with improvement in depressive symptom severity. Am J Psychiatry, 170(6), 633–641. https://doi.org/10.1176/appi.ajp.2012.12020250
Trivedi, Madhukar H., David W. Morris, Stephen R. Wisniewski, Ira Lesser, Andrew A. Nierenberg, Ella Daly, Benji T. Kurian, Bradley N. Gaynes, G. K. Balasubramani, and A John Rush. “Increase in work productivity of depressed individuals with improvement in depressive symptom severity.Am J Psychiatry 170, no. 6 (June 2013): 633–41. https://doi.org/10.1176/appi.ajp.2012.12020250.
Trivedi MH, Morris DW, Wisniewski SR, Lesser I, Nierenberg AA, Daly E, et al. Increase in work productivity of depressed individuals with improvement in depressive symptom severity. Am J Psychiatry. 2013 Jun;170(6):633–41.
Trivedi, Madhukar H., et al. “Increase in work productivity of depressed individuals with improvement in depressive symptom severity.Am J Psychiatry, vol. 170, no. 6, June 2013, pp. 633–41. Pubmed, doi:10.1176/appi.ajp.2012.12020250.
Trivedi MH, Morris DW, Wisniewski SR, Lesser I, Nierenberg AA, Daly E, Kurian BT, Gaynes BN, Balasubramani GK, Rush AJ. Increase in work productivity of depressed individuals with improvement in depressive symptom severity. Am J Psychiatry. 2013 Jun;170(6):633–641.
Journal cover image

Published In

Am J Psychiatry

DOI

EISSN

1535-7228

Publication Date

June 2013

Volume

170

Issue

6

Start / End Page

633 / 641

Location

United States

Related Subject Headings

  • Young Adult
  • Work
  • Venlafaxine Hydrochloride
  • Treatment Outcome
  • Severity of Illness Index
  • Sertraline
  • Selective Serotonin Reuptake Inhibitors
  • Psychiatry
  • Psychiatric Status Rating Scales
  • Middle Aged