The treatment of chronic depression, part 3: psychosocial functioning before and after treatment with sertraline or imipramine.
BACKGROUND
Previous research has suggested that depressed patients, and particularly chronically depressed patients, have significant impairments in many areas of their lives. While previous studies suggested that these "psychosocial" impairments improve following pharmacologic treatment, no large scale definitive study using multiple measures of psychosocial functioning has been reported.


METHODS
We assessed multiple domains of psychosocial functioning using interviewer-rated and self-report measures within the context of a 12-week acute treatment trial of sertraline and imipramine for patients with chronic depression (double depression and chronic major depression). We also compared the psychosocial functioning data of this sample before and after treatment with normative data available from published community samples.


RESULTS
Chronically depressed patients manifested severe impairments in psychosocial functioning at baseline. After treatment with sertraline or imipramine, psychosocial functioning improved significantly. Significant improvements appeared relatively early in treatment (week 4). Despite these highly significant improvements in functioning during acute treatment, the study sample as a whole did not achieve levels of psychosocial functioning comparable to a comparator nondepressed community sample. However, patients who reached full symptomatic response (remission) during acute treatment did have levels of psychosocial functioning in most areas at endpoint that approached or equaled those of community samples.


CONCLUSIONS
These results indicate that successful antidepressant treatment with sertraline or imipramine can alleviate the severe psychosocial impairments found in chronic depression.
Miller
I W
IW
Rhode Island Hospital and Brown University, Providence 02903, USA.
Keitner
G I
GI
Schatzberg
A F
AF
Klein
D N
DN
Thase
M E
ME
Rush
A J
AJ
Markowitz
J C
JC
Schlager
D S
DS
Kornstein
S G
SG
Davis
S M
SM
Harrison
W M
WM
Keller
M B
MB
D000223:Adaptation, Psychological; D000328:Adult; D000929:Antidepressive Agents, Tricyclic / Q000627:therapeutic use*; D002908:Chronic Disease; D015897:Comorbidity; D003866:Depressive Disorder / Q000188:drug therapy* / Q000523:psychology; D004311:Double-Blind Method; D019263:Dysthymic Disorder / Q000188:drug therapy / Q000523:psychology; D005260:Female; D005500:Follow-Up Studies; D006304:Health Status; D006801:Humans; D007099:Imipramine / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D010549:Personal Satisfaction; D010555:Personality Inventory; D011569:Psychiatric Status Rating Scales; D011788:Quality of Life; D017367:Selective Serotonin Reuptake Inhibitors / Q000627:therapeutic use*; D020280:Sertraline / Q000627:therapeutic use*; D012917:Social Adjustment; D011795:Surveys and Questionnaires; D016896:Treatment Outcome
D000929:Antidepressive Agents, Tricyclic; D007099:Imipramine; D017367:Selective Serotonin Reuptake Inhibitors; D020280:Sertraline