Teasing Out Depression Therapy Effects

Depression improvement may boost work productivity for some patients but not others

/ Author:  / Reviewed by: Robert Carlson, M.D

(RxWiki News) Depression can be tricky to treat. Many options are available, but different individuals respond differently. Further, improvement in one area of life may not mean improvement in another.

A recent study found that work productivity improved for those whose symptoms improved on the medication citalopram.

However, for patients who took a different medication when citalopram didn't work for them, work productivity did not improve much even when their depression symptoms did.

This finding means some patients may require different approaches to find the therapy method that works best for them and their lives.

"Discuss depression treatment options with your psychiatrist."

The study, led by Madhukar H. Trivedi, MD, of the Department of Psychiatry at the University of Texas Southwestern Medical Center at Dallas, aimed to understand how depression treatment affected work productivity.

The researchers included 1,928 patients, aged 18 to 75, in their trial. All the participants were outpatients from one of 14 regional centers from across the US.

These patients were all part of another larger study called the STAR*D study, which attempts to study patients while they are receiving mental health treatment in a naturalistic setting.

All the patients were clinically depressed and completed a standard assessment questionnaire about their work productivity and how much their illness impaired their activities.

Those with bipolar disorder, a psychotic disorder, an eating or obsessive-compulsive disorder or substance abuse issues were excluded.

Then, the participants were all treated with 20 to 40 mg of citalopram (brand name Celexa) a day. At 14 weeks, they were assessed to see if their depression symptoms had improved and then were given another questionnaire about work productivity.

Those who did not respond to citalopram (did not see a decrease in their depression symptoms) were switched to a different clinical trial and received sertraline (brand name Zoloft), sustained-release buproprion (brand name Wellbutrin) or extended-release venlafaxine (brand name Effexor), or they were given sustained-release buproprion in addition to citalopram.

This part of the study also lasted for up to 14 weeks, at which point the participants were assessed again for work productivity.

Those who missed more work at the start of the study were patients who had a history of a suicide attempt, had anxiety symptoms, were young when they first developed depression, were African-American or had more severe depressive symptoms.

Those who missed the least amount of work were patients who lacked insurance.

Meanwhile, those who reported the highest level of impairment in their work productivity at the start of the study were patients with at least a college education, who developed depression at a young age and who had more severe symptoms.

Those not reporting as much impairment at work were more likely to to have less than a high school education, to be African American and to have a history of a suicide attempt.

Levels of education may have influenced how impaired individuals were at work, as jobs might differ between those with higher and lower education.

A person with depression in an office job might have more difficulty completing their work than a person with depression doing manual labor or cashier work.

The researchers found that those who responded to the citalopram and experienced improvement in their symptoms also reported improvements in their work productivity.

However, those who did not respond to the citalopram and were then switched to a different medication did not show a significant improvement in their work productivity from the start to the end of the trial.

This was true whether they responded to the second treatment or not.

"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," the authors wrote.

At the start of the study, 56 percent of the patients reported having missed at least one hour of work in the past week due to illness. At the end of the study, this number had dropped to 46 percent.

Meanwhile, 22 percent reported that they missed 10 hours or more of work in the past week because of their illness at the start of the study. At the end, 15 percent reported missing at least 10 hours.

At the start of the study, 22 percent of the participants reported that they had no impairment at work due to their illness. This percentage increased to 37 percent at the end of the study.

Darold Treffert, MD, a psychiatrist and dailyRx expert, said this study reveals how important it is for patients and doctors to discuss the best treatment for that particular patient.

"Treatment of depression, including choice of anti-depressants when indicated, needs to be individualized and customized to each patient and various treatment options should be the part of the discussion between psychiatrist and patient," Dr. Treffert said.

The study was published April 5 in the American Journal of Psychiatry. The research was funded by the National Institute of Mental Health, and medications for the trial were provided free of charge by Bristol-Myers Squibb, Forest Laboratories, GlaxoSmithKline, King Pharmaceuticals, Organon, Pfizer and Wyeth.

Six of the authors reported extensive ties in speaking, consultancy or research funding to a range of pharmaceutical and other medical industry companies.

Reviewed by: 
Review Date: 
April 9, 2013
Last Updated:
January 27, 2014