TY - JOUR
T1 - Quality of life after response to acute-phase cognitive therapy for recurrent depression
AU - Vittengl, Jeffrey R.
AU - Jha, Manish K.
AU - Minhajuddin, Abu
AU - Thase, Michael E.
AU - Jarrett, Robin B.
N1 - Funding Information:
This report was supported by Grants Number K24 MH001571, R01 MH58397, R01 MH69619 (to Robin B. Jarrett, Ph.D.) and R01 MH58356 and R01 MH69618 (to Michael E. Thase, M.D.) from the National Institute of Mental Health (NIMH). The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIMH or the National Institutes of Health.
Funding Information:
We appreciate the careful review by members of the trial's Data Safety and Monitoring Board. We are indebted to our research teams and our colleagues at The University of Texas Southwestern Medical Center, the University of Pittsburgh (where Dr. Thase was located during patient accrual), and the University of Pennsylvania (Dr. Thase's current affiliation).We appreciate the participation of colleagues, previously named, and study participants without whom such research could not have been completed.
Funding Information:
Dr. Vittengl is a paid reviewer for UpToDate. Dr. Jha has received research grants from Acadia Pharmaceuticals and Janssen Research & Development and honoraria from the North American Center for Continuing Medical Education and Global Medical Education.Dr. Minhajuddin reports no financial relationships with commercial interests relevant to this work. Dr. Thase has consulted with and/or served on advisory boards for Alkermes, Allergan (includes Forest Laboratories), AstraZeneca, Cerecor, Johnson & Johnson (includes Janssen), Lundbeck, MedAvante, Merck, Moksha8, Otsuka, Pfizer Pharmaceuticals, Shire, Sunovion, and Takeda; he has received grant support from Alkermes, Allergan (includes Forest Laboratories), Assurerx, Johnson & Johnson, Takeda, the Agency for Healthcare Research and Quality, Patient Centered Outcomes Research Institute and the NIMH. He has equity holdings for MedAvante, Inc. and has received royalties from American Psychiatric Publishing, Inc. (APPI), Guilford Publications, Herald House, and W.W. Norton & Company, Inc. Dr. Thase’s spouse is an employee of Peloton Advantage, which does business with several pharmaceutical companies.Dr. Jarrett is a paid consultant to the NIH, NIMH, and UpToDate. She has stock equity in Amgen, Johnson and Johnson, and Proctor and Gamble. Her medical center charges fees for the cognitive therapy she provides to patients.
Publisher Copyright:
© 2020
PY - 2021/1/1
Y1 - 2021/1/1
N2 - Background: Adults with major depressive disorder (MDD) often experience reduced quality of life (QOL). Efficacious acute-phase treatments, including cognitive therapy (CT) or medication, decrease depressive symptoms and, to a lesser degree, increase QOL. We tested longer-term changes in QOL after response to acute-phase CT, including the potential effects of continuation treatment for depression and time-lagged relations between QOL and depressive symptoms. Methods: Responders to acute-phase CT (N = 290) completed QOL and depressive symptom assessments repeatedly for 32 post-acute months. Higher-risk responders were randomized to 8 months of continuation treatment (CT, fluoxetine, or pill placebo) and then entered a 24-month follow-up. Lower-risk responders were only assessed for 32 months. Results: On average, large gains in QOL made during acute-phase CT response were maintained for 32 months. Continuation CT or fluoxetine did not improve QOL relative to pill placebo. Controlling for residual depressive symptoms, higher QOL after acute-phase CT response was a protective factor against MDD relapse and recurrence. Higher QOL predicted subsequent reductions in depressive symptom severity, but depressive symptom severity did not predict subsequent changes in QOL. Limitations: Generalization of results to other patient populations, treatments, and measures is uncertain. The clinical trial was not designed to test relations between QOL and depression. Replication is needed before clinical application of these results. Conclusions: Gains in QOL made during response to acute-phase CT are relatively stable and may help protect against relapse/recurrence. Continuation CT or fluoxetine may not further improve QOL among acute-phase CT responders.
AB - Background: Adults with major depressive disorder (MDD) often experience reduced quality of life (QOL). Efficacious acute-phase treatments, including cognitive therapy (CT) or medication, decrease depressive symptoms and, to a lesser degree, increase QOL. We tested longer-term changes in QOL after response to acute-phase CT, including the potential effects of continuation treatment for depression and time-lagged relations between QOL and depressive symptoms. Methods: Responders to acute-phase CT (N = 290) completed QOL and depressive symptom assessments repeatedly for 32 post-acute months. Higher-risk responders were randomized to 8 months of continuation treatment (CT, fluoxetine, or pill placebo) and then entered a 24-month follow-up. Lower-risk responders were only assessed for 32 months. Results: On average, large gains in QOL made during acute-phase CT response were maintained for 32 months. Continuation CT or fluoxetine did not improve QOL relative to pill placebo. Controlling for residual depressive symptoms, higher QOL after acute-phase CT response was a protective factor against MDD relapse and recurrence. Higher QOL predicted subsequent reductions in depressive symptom severity, but depressive symptom severity did not predict subsequent changes in QOL. Limitations: Generalization of results to other patient populations, treatments, and measures is uncertain. The clinical trial was not designed to test relations between QOL and depression. Replication is needed before clinical application of these results. Conclusions: Gains in QOL made during response to acute-phase CT are relatively stable and may help protect against relapse/recurrence. Continuation CT or fluoxetine may not further improve QOL among acute-phase CT responders.
KW - Cognitive therapy
KW - Continuation treatment
KW - Pharmacotherapy
KW - Quality of life
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U2 - 10.1016/j.jad.2020.09.059
DO - 10.1016/j.jad.2020.09.059
M3 - Article
C2 - 32971314
AN - SCOPUS:85091201881
SN - 0165-0327
VL - 278
SP - 218
EP - 225
JO - Journal of Affective Disorders
JF - Journal of Affective Disorders
ER -