title: Residual symptoms and functioning in depression, does the type of residual symptom matter? A post-hoc analysis.
abstract: BACKGROUND
  The degrees to which residual symptoms in major depressive disorder (MDD) adversely affect patient functioning is not known. This post-hoc analysis explored the association between different residual symptoms and patient functioning.
  
  
  METHODS
  Patients with MDD who responded (≥50% on the 17-item Hamilton Rating Scale for Depression; HAMD-17) after 3 months of treatment (624/930) were included. Residual core mood-symptoms (HAMD-17 core symptom subscale ≥1), residual insomnia-symptoms (HAMD-17 sleep subscale ≥1), residual anxiety-symptoms (HAMD-17-anxiety subscale ≥1), residual somatic-symptoms (HAMD-17 Item 13 ≥1), pain (Visual Analogue Scale ≥30), and functioning were assessed after 3 months treatment. A stepwise logistic regression model with normal functioning (Social and Occupational Functioning Assessment Scale ≥80) as the dependent variable was used.
  
  
  RESULTS
  After 3 months, 59.5% of patients (371/624) achieved normal functioning and 66.0% (412/624) were in remission. Residual symptom prevalence was: core mood symptoms 72%; insomnia 63%; anxiety 78%; and somatic symptoms 41%. Pain reported in 18%. Factors associated with normal functioning were absence of core mood symptoms (odds ratio [OR] 8.7; 95% confidence interval [CI], 4.6-16.7), absence of insomnia symptoms (OR 1.8; 95% CI, 1.2-2.7), episode length (4-24 weeks vs. ≥24 weeks [OR 2.0; 95% CI, 1.1-3.6]) and better baseline functioning (OR 1.0; 95% CI, 1.0-1.1). A significant interaction between residual anxiety symptoms and pain was found (p = 0.0080).
  
  
  CONCLUSIONS
  Different residual symptoms are associated to different degrees with patient functioning. To achieve normal functioning, specific residual symptoms domains might be targeted for treatment.
authors: Department of Clinical Research Lilly, S.A. Avenida de la Industria 30, 28108, Alcobendas, Spain. romera_irene@lilly.com
authors: Irene
authors: I
authors: Romera
authors: Víctor
authors: V
authors: Pérez
authors: Antonio
authors: A
authors: Ciudad
authors: Luis
authors: L
authors: Caballero
authors: Miguel
authors: M
authors: Roca
authors: Pepa
authors: P
authors: Polavieja
authors: Inmaculada
authors: I
authors: Gilaberte
mesh_terms: D000203:Activities of Daily Living / Q000523:psychology; D003865:Major Depressive Disorder / Q000523:psychology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011569:Psychiatric Status Rating Scales; D012074:Remission Induction; D016896:Treatment Outcome
references: Psychol Med. 2011 Jun;41(6):1165-74
references: 20932356
references: Anesth Analg. 1998 Jan;86(1):102-6
references: 9428860
references: Psychol Med. 2010 Jan;40(1):41-50
references: 19460188
references: Eur Psychiatry. 2010 Jan;25(1):52-7
references: 19695844
references: Compr Psychiatry. 2007 Mar-Apr;48(2):113-7
references: 17292700
references: Turk Psikiyatri Derg. 2007 Winter;18(4):323-32
references: 18066723
references: J Affect Disord. 2010 Dec;127(1-3):160-8
references: 20541811
references: J Affect Disord. 2011 Nov;134(1-3):235-41
references: 21676465
references: Int Clin Psychopharmacol. 2010 Mar;25(2):68-74
references: 20061961
references: J Affect Disord. 2007 Nov;103(1-3):77-82
references: 17321595
references: Psychol Med. 1995 Nov;25(6):1171-80
references: 8637947
references: Psychiatry Res. 2011 Mar 30;186(1):133-7
references: 20659770
references: J Clin Psychopharmacol. 2011 Apr;31(2):180-6
references: 21346613
references: Eur Psychiatry. 2010 Jan;25(1):58-65
references: 19553092
references: Depress Anxiety. 2011 Feb;28(2):137-44
references: 21284066
references: Anesthesiology. 2001 Dec;95(6):1356-61
references: 11748392
references: J Affect Disord. 1998 Sep;50(2-3):97-108
references: 9858069
references: J Clin Psychiatry. 1998 Nov;59(11):608-19
references: 9862607
references: J Neurol Neurosurg Psychiatry. 1960 Feb;23:56-62
references: 14399272
references: JAMA. 2003 Jun 18;289(23):3152-60
references: 12813121
references: Depress Anxiety. 2008;25(12):1060-6
references: 18781665
references: J Affect Disord. 2010 Jun;123(1-3):181-7
references: 19733912
references: J Clin Psychiatry. 2012 Feb;73(2):185-91
references: 22053897
references: Am J Psychiatry. 1992 Sep;149(9):1148-56
references: 1386964
references: Eur Arch Psychiatry Clin Neurosci. 2010 Mar;260(2):145-50
references: 19572158
references: Surg Clin North Am. 1999 Apr;79(2):231-52
references: 10352653
references: J Affect Disord. 2004 Oct 15;82(2):291-6
references: 15488260