TY - JOUR
T1 - Early normalization of Quality of Life predicts later remission in depression
T2 - Findings from the CO-MED trial
AU - Jha, Manish K.
AU - Greer, Tracy L.
AU - Grannemann, Bruce D.
AU - Carmody, Thomas
AU - Rush, A. John
AU - Trivedi, Madhukar H.
N1 - Funding Information:
The authors thank the clinical staff at each clinical site including site investigators and co-investigators for their assistance with this project; all of the study participants; Eric Nestler, M.D., Ph.D., Carol A. Tamminga, M.D., and Savitha Kalidas, Ph.D. for administrative support. This work was also supported in part through the Center for Depression Research and Clinical Care (Principal Investigator: Madhukar H. Trivedi, MD) and Hersh Foundation . An earlier version of this manuscript was reviewed by Dr. Michael Frisch, Professor of Psychology, Baylor University, Waco, TX. The authors thank Dr. Frisch for his valuable feedback on descriptive information regarding the Quality of Life Inventory.
Funding Information:
Dr. Jha, Mr. Grannemann, and Dr. Carmody report no conflicts of interest. Dr. Greer has received research funding from NARSAD and honoraria and/or consultant fees from H. Lundbeck A/S and Takeda Pharmaceuticals International, Inc. Dr. Rush has received consulting fees from the American Psychiatric Association, Brain Resource Ltd, H. Cyberonics, Eli Lilly, Emmes Corp, Lundbeck A/S, Medavante, Inc; National Institute of Drug Abuse; Santium Inc.; Takeda USA and the University of Colorado; speaking fees from the University of California at San Diego, Hershey Penn State Medical Center, the American Society for Clinical Psychopharmacology; the New York State Psychiatric Institute; Stanford Medical School; royalties from Guilford Publications and the University of Texas Southwestern Medical Center; and research support from Duke-National University of Singapore. Dr. Madhukar H. Trivedi, is or has been an advisor/consultant and received fee from: Alkermes, AstraZeneca, Cerecor, Eli Lilly & Company, Lundbeck, Naurex, Neuronetics, Otsuka Pharmaceuticals, Pamlab, Pfizer Inc., SHIRE Development and Takeda. In addition, he has received grants/research support from: National Institute of Mental Health and National Institute on Drug Abuse.
Publisher Copyright:
© 2016 Elsevier B.V.
PY - 2016/12/1
Y1 - 2016/12/1
N2 - Background Although normal Quality of Life (QoL) is the outcome desired by patients, it is unclear if QoL changes early in course of antidepressant treatments are independent of depression severity, and can predict subsequent remission. Methods The Quality of Life Inventory was obtained repeatedly in the Combining Medications to Enhance Depression Outcomes trial. Mixed model analyses assessed QoL change. Using population-based norms, participants were grouped as very low, low, or normal QoL at week 4, and association with remission was evaluated. Results Overall baseline to week 4 QoL improved significantly (p=0.0015) even after controlling for change in depression severity and baseline variables (gender, age, education, race, ethnicity, income, employment status, anxious features, depression onset before age 18, suicidal ideations, and treatment-arm). At week 4, participants with low and normal QoL had higher unadjusted odds ratio (OR) for remission at 3 months (low QoL OR=2.36, 95% confidence interval (CI)=1.25,4.44; normal QoL OR=2.59, 95% CI=1.53,4.39) and 7 months (low QoL OR=2.07, 95% CI=1.00,4.31; normal QoL OR=3.98, 95% CI=2.06,7.69) compared to those with very low QoL. Remission rates, adjusted for baseline variables, were higher only for participants with normal QoL (3 months OR=2.83, 95% CI=1.42,5.68; 7 months OR=6.10, 95% CI=2.40,15.63). Limitations Secondary analysis, short period of assessment for QoL change, remission instead of functional recovery as long-term outcome. Conclusion Quality of life improves early, independent of depression severity. Normal QoL at week 4 is associated with 2–6 times higher remission rates. Findings support QoL beyond symptomatic change as a potential mediator of remission.
AB - Background Although normal Quality of Life (QoL) is the outcome desired by patients, it is unclear if QoL changes early in course of antidepressant treatments are independent of depression severity, and can predict subsequent remission. Methods The Quality of Life Inventory was obtained repeatedly in the Combining Medications to Enhance Depression Outcomes trial. Mixed model analyses assessed QoL change. Using population-based norms, participants were grouped as very low, low, or normal QoL at week 4, and association with remission was evaluated. Results Overall baseline to week 4 QoL improved significantly (p=0.0015) even after controlling for change in depression severity and baseline variables (gender, age, education, race, ethnicity, income, employment status, anxious features, depression onset before age 18, suicidal ideations, and treatment-arm). At week 4, participants with low and normal QoL had higher unadjusted odds ratio (OR) for remission at 3 months (low QoL OR=2.36, 95% confidence interval (CI)=1.25,4.44; normal QoL OR=2.59, 95% CI=1.53,4.39) and 7 months (low QoL OR=2.07, 95% CI=1.00,4.31; normal QoL OR=3.98, 95% CI=2.06,7.69) compared to those with very low QoL. Remission rates, adjusted for baseline variables, were higher only for participants with normal QoL (3 months OR=2.83, 95% CI=1.42,5.68; 7 months OR=6.10, 95% CI=2.40,15.63). Limitations Secondary analysis, short period of assessment for QoL change, remission instead of functional recovery as long-term outcome. Conclusion Quality of life improves early, independent of depression severity. Normal QoL at week 4 is associated with 2–6 times higher remission rates. Findings support QoL beyond symptomatic change as a potential mediator of remission.
KW - Major depressive disorder
KW - Measurement based care
KW - Quality of Life
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U2 - 10.1016/j.jad.2016.07.012
DO - 10.1016/j.jad.2016.07.012
M3 - Article
C2 - 27455354
AN - SCOPUS:84978819029
SN - 0165-0327
VL - 206
SP - 17
EP - 22
JO - Journal of affective disorders
JF - Journal of affective disorders
ER -