PracticeUpdate Conference Series European Congress of Psychiatry 2019

Symptom Remission May Not Equate to Functional Recovery in Depression Functional deficits related to cognitive and depressive symptoms may persist.

P atients with major depressive disorder who meet the criteria for remission of depressive symptoms may still face functional impairment, according to research presented at EPA 2019. While many physicians assume that patients for whom antidepressant therapy has led to remission of depressive symptoms of major depressive dis- order can return to a normal level of functioning, research conducted by Antonios Chatzimanolis, MD, a practicing psychiatrist in Athens, Greece, and colleagues suggest this might not always be the case. Dr. Chatzimanolis and colleagues noted in their abstract that almost half of patients diagnosed with major depressive disorder who meet symptom- based definitions of remission, as measured by commonly used rating scales, do not consider their condition to be truly in remission and continue to experience functional impairment. As a result, it is important to evaluate functional recovery in multiple domains, including school, work and home life, among patients being treated for depression. The investigators conducted a non-interventional, cross-sectional multi-site study of 335 outpatients

in routine clinical practice in Greece who had been diagnosed with major depressive disorder and who had experienced a clinical response to antidepressant therapy. Remission of depression was defined as a Montgomery-Åsberg Depression Rating Scale (MADRS) score ≤12, and functional recovery was defined as a Sheehan Disability Scale total score (SDS) ≤6. Cognitive symptoms were assessed using the Perceived Deficits Questionnaire-Depression (PDQ-D). Overall, 198 patients (53.7%) were evaluated as being remitted and 135 (40.3%) were functionally recovered. Among the patients who met the crite- ria for remission, only 113 (57%) also met the criteria for functional recovery. Functional recovery correlated significantly with MADRS total score (P < .001, beta-coefficient = –0.155) and with PDQ-D total score (P = .045, beta-coefficient = –0.039). The authors concluded that functional recovery remains an unmet need among a proportion of patients whose depressive symptoms have remit- ted. Lack of functional recovery appears to be linked to both depressive and cognitive symptoms. In a comment on the study for Elsevier’s PraticeUpdate , Dennis Butler, PhD, Professor Emeritus of Family Medicine at the Medical College of Wisconsin in Milwaukee, said, “As many of my mentors so often proclaimed, ‘treat the patient, not the lab!’ As this study confirms, that dictum also applies to the treatment of depressed patients whose scores on common depression screening

" Symptom checklists have their limitations and do not assess functionality. So, the study authors are onto something. It is necessary to ask patients about their current functioning. " PRACTICEUPDATE CONFERENCE SERIES • EPA 2019 14