Clinical and functional remission assessment in patients with recurrent depression
https://doi.org/10.14412/2074-2711-2019-4-88-93
Abstract
Objective: to make a clinical-scale assessment of remission in patients with recurrent depression.
Patients and methods. The clinical and functional characteristics of remission were investigated in 121 patients with recurrent depression. The investigators used the following tests: the Montgomery-Asberg Depression Rating Scale (MADRS), the Brief Assessment of Cognition in Affective Disorders (BAC-A), the WHO Disability Assessment Schedule 2.0 (WHODAS 2.0), and the 36-item Short Form Health Survey (SF-36) questionnaire. They systematized remission, by identifying its four types: asymptomatic, that with asthenic symptoms, that with anxiety symptoms, hypothymic.
Results and discussion. The criteria for complete remission with its average duration of 6 months were met in 58.6% of patients. Impaired social functioning was observed in all patients in remission. The predictors of incomplete remission were a family history; male gender; complex pattern of depression; and the presence of comorbid anxiety. The anxious variant of incomplete remission predominated, suggesting that it is advisable to choose anxiolytic antidepressants for maintenance therapy. New-generation antidepressant therapy is more frequently associated with complete remission. Whether therapy with different antidepressants might achieve functional remission was studied using agomelatine as an example.
Conclusion. When assessing the results of treatment for depression, it is necessary to take into account not only clinical changes, but also social functioning in patients and, as a target of therapy to identify positive affect as one of the psychological parameters of quality of life. When choosing an antidepressant for the maintenance therapy of recurrent depression, its positive efficacy on the social functioning of patients should be an important criterion.
About the Author
N. N. Petrova
Department of Psychiatry and Narcology, Saint Petersburg State University
Russian Federation
7/9, Universitetskaya Embankment, Saint Petersburg 199034
Russian Federation
7/9, Universitetskaya Embankment, Saint Petersburg 199034
References
1. Vos T, Allen C, Arora M, et al. Global, regional and national incidence, prevalence, and years lived with disability for 310 diseases and injuries, 1990–2015: a systematic analysis for the Global Burden of Disease Study 2015. Lancet. 2016 Oct 8;388(10053):1545-1602. doi: 10.1016/S0140-6736(16)31678-6.
2. Collins PY, Patel V, Joestl SS, et al. Grand challenges in global mental health. Nature. 2011 Jul 6;475(7354):27-30. doi: 10.1038/475027a.
3. Whiteford H, Harris M, McKeon G, et al. Estimating remission from untreated major depression: a systematic review and meta-analysis. Psychol Med. 2013 Aug;43(8):1569-85. doi: 10.1017/S0033291712001717. Epub 2012 Aug 10.
4. World Health Organization. Depression and other common mental disorders: global health estimates. Depression and other common mental disorders. World Health Organization. Geneva; 2017.
5. Kulikov AYu, Dedyurina YuM. Analysis of the cost of treatment of patients suffering from depressive disorders in the health care of the Russian Federation. Farmakoekonomika. Sovremennaya farmakoekonomika i farmakoepidemiologiya. 2011;4(1):24-33. (In Russ.)
6. Johnston KM. The burden of treatmentresistant depression: A systematic review of the economic and quality of life literature. J Affect Disord. 2019 Jan 1;242:195-210. doi: 10.1016/j.jad.2018.06.045. Epub 2018 Jun 27.
7. Ferrari AJ, Charlson FJ, Norman RE, et al. Burden of Depressive Disorders by Country, Sex, Age, and Year: Findings from the Global Burden of Disease Study 2010. PLoS Med. 2013 Nov;10(11):e1001547. doi: 10.1371/journal.pmed.1001547. Epub 2013 Nov 5.
8. Rush AJ, Wisniewski SR, Zisook S et al. Is prior course of illness relevant to acute or longer-term outcomes in depressed out-patients? A STAR* D report. Psychol Med. 2012 Jun;42(6): 1131-49. doi: 10.1017/S0033291711002170. Epub 2011 Oct 19.
9. Frank E, Prien RF, Jarrett RB, et al. Conceptualization and rationale for consensus definitions of terms in major depressive disorder. Remission, recovery, relapse, and recurrence. Arch Gen Psychiatry. 1991 Sep;48(9):851-5.
10. Gorodnichev AV, Kostyukova EG, Mosolov SN. Achieving remission as the main goal of long-term therapy of recurrent depressive disorder. Sovremennaya terapiya psikhicheskikh rasstroistv. 2009;(1):5-10. (In Russ.)]
11. Zimmerman M, McGlinchey JB, Posternak MA, et al. How should remission from depression be defined? The depressed patient's perspective. Am J Psychiatry. 2006 Jan;163(1):148-50.
12. Demyttenaere K, Donneau AF, Albert A, et al. What is important in being cured from depression. Discordance between physicians and patients. J Affect Disord. 2015 Mar 15; 174:390-6. doi: 10.1016/j.jad.2014.12.004. Epub 2014 Dec 10.
13. Hanoun N, Moscaer E, Boyer PA, et al. Differential effects of the novel antidepressant agomelatine (S 20098) versus fluoxetine on 5-HT2a receptors in the rat brain. Neuropharmacology. 2004 Sep;47(4):515-26.
14. Kroenke K. Somatic symptoms and depression: a double hurt. Prim Care Companion J Clin Psychiatry. 2005;7(4):148-9.
15. Smulevich AB, Andryushchenko AV, Romanov DV, et al. Remissions in affective diseases: epidemiology, psychopathology, clinical and social prognosis, secondary prevention. Zhurnal nevrologii i psikhiatrii im. S.S. Korsakova. 2014;114(3):4-13. (In Russ.)
16. Pintor L, Gastro C, Navarro V, et al. Relapse of major depression after complete and partial remission during a 2-year follow-up. J Affect Disord. 2003 Feb;73(3):237-44.
17. Pintor L, Torres X, Navarro V, et al. Is the type of remission after a major depressive episode an important risk factor to relapses in a 4-year follow up? J Affect Disord. 2004 Oct 15; 82(2):291-6.
18. Romera I, Perez V, Gilaberte I. Remission and functioning in major depressive disorder. Actas Esp Psiquiatr. 2013 Sep-Oct;41(5):263-8.Epub 2013 Sep 1.
19. Sarfati D, Stewart K, Woo C, et al. The effect of remission status on work functioning in employed patients treated for major depressive disorder. Ann Clin Psychiatry. 2017 Feb;29(1):11-16.
20. Bun'kova KM, Izyumina TA, Repin SA. The formation of remission and quality of life in patients with non-psychotic depression. Vestnik nevrologii, psikhiatrii i psikhokhirurgii. 2014;(8):3-7. (In Russ.)
21. Judd LL, Akiskal HS, Maser JD, et al. Major depressive disorder: a prospective study of residual subthreshold depressive symptoms as predictor of rapid relapse. J Affect Disord. 1998 Sep;50(2-3):97-108.
22. Stahl SM. Antidepressants and somatic symptoms: therapeutic actions are expanding beyond affective spectrum disorders to functional somatic syndromes. J Clin Psychiatry. 2003 Jul;64(7):745-6.
23. Fava M. Somatic symptoms, depression, and antidepressant treatment. J Clin Psychiatry. 2002 Apr;63(4):305-7.
24. Charnsil C, Suttajit S, Boonyanaruthee V, et al. An open-label study of adjunctive repetitive transcranial magnetic stimulation (rTMS) for partial remission in major depressive disorder. Int J Psychiatry Clin Pract. 2012 Jun;16(2): 98-102. doi: 10.3109/13651501.2011.632681. Epub 2012 Feb 17.
25. Harada E, Satoi Y, Kikuchi T, et al. Residual symptoms in patients with partial versus complete remission of a major depressive disorder episode: patterns of painful physical symptoms in depression. Neuropsychiatr Dis Treat. 2016 Jun 30;12:1599-607. doi: 10.2147/NDT.S102767. eCollection 2016.
26. American Psychiatric Association. Diagnostic and statistical manual of mental disorders: DSM-5. Diagnostic and statistical manual of mental disorders. 5th ed. American Psychiatric Association: Washington, D.C.; 2013. 947 p.
27. Zimmerman M, Chelminski I, Posternak M. A review of studies of the Montgomery-Asberg Depression Rating Scale in controls: implications for the definition of remission in treatment studies of depression. Int Clin Psychopharmacol. 2004 Jan;19(1):1-7.
28. Zimmerman M, Chelminski I, Posternak M. A review of studies of the Hamilton depression rating scale in healthy controls: implications for the definition of remission in treatment studies of depression. J Nerv Ment Dis. 2004 Sep;192(9): 595-601.
29. Vazagaeva TI. The quality and persistence of remission in the use of antidepressants and transpersonal psychotherapy in patients with depressive disorders. Rossiiskii psikhiatricheskii zhurnal. 2009;(6):58-65. (In Russ.)
30. Kanaeva LS. The modern concept of remission in non-psychotic depressive disorders. Zhurnal nevrologii i psikhiatrii im. S.S. Korsakova. 2013;113(11):14-22. (In Russ.)
31. Van Randenborgh A, Hü ffmeier J, Victor D, et al. Contrasting chronic with episodic depression: An analysis of distorted socio-emotional information processing in chronic depression. J Affect Disord. 2012 Dec 10;141(2-3):177-84. doi: 10.1016/j.jad.2012.02.039. Epub 2012 Apr 18.
32. De Vries G, Koeter MW, Nieuwenhuijsen K, et al. Predictors of impaired work functioning in employees with major depression in remission. J Affect Disord. 2015 Oct 1;185:180-7. doi: 10.1016/j.jad.2015.07.013. Epub 2015 Jul 9.
33. Rubio JM, Olfson M, Villegas L, et al. Quality of life following remission of mental disorders: findings from the National Epidemiologic Survey on Alcohol and Related Conditions. J Clin Psychiatry. 2013 May;74(5): e445-50. doi: 10.4088/JCP.12m08269.
34. Van der Voort TY, Seldenrijk A, van Meijel B, et al. Functional versus syndromal recovery in patients with major depressive disorder and bipolar disorder. J Clin Psychiatry. 2015 Jun; 76(6):e809-14. doi: 10.4088/JCP.14m09548.
35. Cotrena C, Branco LD, Shansis F, et al. Executive function impairments in depression and bipolar disorder: association with functional impairment and quality of life. J Affect Disord. 2016 Jan 15;190:744-753. doi: 10.1016/j.jad.2015.11.007. Epub 2015 Nov 12.
36. Buist-Bouwman MA, Ormel J, de Graaf R, et al. Mediators of the association between depression and role functioning. Acta Psychiatr Scand. 2008 Dec;118(6):451-8. doi: 10.1111/j.1600-0447.2008.01285.x. Epub 2008 Oct 14.
37. Hammer-Helmich L, Haro JM, Jö nsson B, et al. Functional impairment in patients with major depressive disorder: the 2-year PERFORM study. Neuropsychiatr Dis Treat. 2018 Jan 9;14:239-249. doi: 10.2147/NDT.S146098.eCollection 2018.
38. Stotland N. Recovery from depression. Psychiatr Clin North Am. 2012 Mar;35(1):37-49. doi: 10.1016/j.psc.2011.11.007. Epub 2011 Dec 15.
39. Üstü n TB, Chatterji S, Kostanjsek N, et al. Epping-Jordan J., Saxena S., von Korff M., Pull C. Developing the World Health Organization Disability Assessment Schedule 2.0. Bull World Health Organ. 2010 Nov 1; 88(11):815-23. doi: 10.2471/BLT.09.067231. Epub 2010 May 20.
40. Zimmerman M, Posternak MA, Chelminski I. Derivation of a definition of remission on the Montgomery-Asberg depression rating scale corresponding to the definition of remission on the Hamilton rating scale for depression. J Psychiatr Res. 2004 Nov-Dec;38(6):577-82.
41. Madhoo M, Keefe RS, Roth RM, et al. Lisdexamfetamine Dimesylate Augmentation in Adults With Persistent Executive Dysfunction After Partial or Full Remission of Major Depressive Disorder. Neuropsychopharmacology. 2014 May;39(6):1388-98. doi: 10.1038/npp.2013.334. Epub 2013 Dec 6.
42. Zakharova KV. The quality and persistence of remission in the use of pharmacotherapy in patients with depressive disorders. Autoref. diss. cand. med. sci. Moscow; 2008. 140 p.
43. Gvozdetskii AN, Petrova NN, Akulin IM. The effect of cognitive impairment in recurrent depression on the social functioning of patients in remission. Sotsial'naya i klinicheskaya psikhiatriya. 2019;29(1):5-9. (In Russ.)
44. Kennedy SH, Heun R, Avedisova A, et al. Effect of agomelatine 25-50 mg on functional outcomes in patients with major depressive disorder. J Affect Disord. 2018 Oct 1;238:122-128. doi: 10.1016/j.jad.2018.05.060. Epub 2018 May 29.
45. Kennedy SH, Avedisova A, BelaÏdi C, et al. Sustained efficacy of agomelatine 10 mg, 25 mg, and 25-50 mg on depressive symptoms and functional outcomes in patients with major depressive disorder. A placebo-controlled study over 6 months. Eur Neuropsychopharmacol. 2016 Feb;26(2):378-389. doi: 10.1016/j.euroneuro.2015.09.006. Epub 2015 Sep 25.
46. Taylor DJ, Walters HM, Vittengl JR, et al. Which depressive symptoms remain after response to cognitive therapy of depression and predict relapse and recurrence? J Affect Disord. 2010 Jun;123(1-3):181-7. doi: 10.1016/j.jad.2009.08.007. Epub 2009 Sep 5.
47. Keedwell PA, Andrew C, Williams SC, et al. The neural correlates of anhedonia in major depressive disorder. Biol Psychiatry. 2005 Dec 1; 58(11):843-53. Epub 2005 Jul 25.
48. Cao B, Zhu J, Zuckerman H, et al. Pharmacological interventions targeting anhedonia in patients with major depressive disorder: A systematic review. Prog Neuropsychopharmacol Biol Psychiatry. 2019 Jun 8;92:109-117. doi: 10.1016/j.pnpbp.2019.01.002. Epub 2019 Jan 3.
49. Di Giannantonio M, Di Iorio G, Guglielmo R, et al. Major depressive disorder, anhedonia and agomelatine: an open-label study. J Biol Regul Homeost Agents. 2011 Jan-Mar; 25(1):109-14.
50. Llorca PM, Gourion P. P.2.f.028. Course of anhedonia and depressive symptoms in a population of depressed outpatients treated with agomelatine. Eur Neuropsychopharmacol. 2014; 24(suppl 2):468. doi: 10.1016/s0924-977x(14)70749-7
51. Gorwood P, Benichou J, Rouillon F, Wattez M. Efficacy and safety of agomelatine over one year. A French prospective observational study of depressed patients followed-up in medical practice. European Neuropsychopharmacology. 2016;26(suppl 2): 456-7. doi: 10.1016/S0924-977X(16)31448-1
52. Avedisova AS, Zakharova KV, Marachev MP. The results of observational studies «JAZZ» – «The efficacy of agomelatine (Valdoxan) in the treatment of patients with anxious depression as part of a major depressive disorder». Psikhiatriya i psikhofarmakoterapiya im. P.B. Gannushkina. 2013;(6):14-22. (In Russ.)
53. Vorob'eva OV. Valdoxan in depression therapy in neurological practice: results of the Russian multicenter naturalistic study «Resonance». Zhurnal nevrologii i psikhiatrii im. S.S. Korsakova. 2012;112(9):47-51. (In Russ.)
54. Chernova EV, Kozhechkina OV, Ter-Israelyan AYu, Medvedev VE. Therapy with agomelatin (valdoxan) for endogenous depression in a day hospital. Zhurnal nevrologii i psikhiatrii im. S.S. Korsakova. 2016;116(10):43-6.(In Russ.)
55. Petrova NN. On the treatment of depression in patients with schizophrenia. Psikhiatriya i psikhofarmakoterapiya im. P.B. Gannushkina. 2014;(2):25-8. (In Russ.)
56. Khoo AL, Zhou HJ, Teng M, et al. Network Meta-Analysis and Cost-Effectiveness Analysis of New Generation Antidepressants. CNS Drugs. 2015 Aug;29(8):695-712. doi: 10.1007/s40263-015-0267-6.
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For citations:
Petrova N.N. Clinical and functional remission assessment in patients with recurrent depression. Neurology, Neuropsychiatry, Psychosomatics. 2019;11(4):88-93. (In Russ.) https://doi.org/10.14412/2074-2711-2019-4-88-93
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