title: Increase in work productivity of depressed individuals with improvement in depressive symptom severity.
abstract: OBJECTIVE
  The authors sought to identify baseline clinical and sociodemographic characteristics associated with work productivity in depressed outpatients and to assess the effect of treatment on work productivity.
  
  
  METHODS
  Employed depressed outpatients 18-75 years old who completed the Work Productivity and Activity Impairment scale (N=1,928) were treated with citalopram (20-40 mg/day) in the Sequenced Treatment Alternatives to Relieve Depression study. For patients who did not remit after an initial adequate antidepressant trial (level 1), either a switch to sertraline, sustained-release bupropion, or extended-release venlafaxine or an augmentation with sustained-release bupropion or buspirone was provided (level 2). Participants' clinical and demographic characteristics and treatment outcomes were analyzed for associations with baseline work productivity and change in productivity over time.
  
  
  RESULTS
  Education, baseline depression severity, and melancholic, atypical, and recurrent depression subtypes were all independently associated with lower benefit to work productivity domains. During level 1 treatment, work productivity in several domains improved with reductions in depressive symptom severity. However, these findings did not hold true for level 2 outcomes; there was no significant association between treatment response and reduction in work impairment. Results were largely confirmed when multiple imputations were employed to address missing data. During this additional analysis, an association was also observed between greater impairment in work productivity and higher levels of anxious depression.
  
  
  CONCLUSIONS
  Patients with clinically significant reductions in symptom severity during initial treatment were more likely than nonresponders to experience significant improvements in work productivity. In contrast, patients who achieved symptom remission in second-step treatment continued to have impairment at work. Patients who have demonstrated some degree of treatment resistance are more prone to persistent impairment in occupational productivity, implying a need for additional, possibly novel, treatments.
authors.affiliation: Department of Psychiatry, University of Texas Southwestern Medical Center at Dallas, USA. madhukar.trivedi@utsouthwestern.edu
authors.forename: Madhukar H
authors.initials: MH
authors.lastname: Trivedi
authors.forename: David W
authors.initials: DW
authors.lastname: Morris
authors.forename: Stephen R
authors.initials: SR
authors.lastname: Wisniewski
authors.forename: Ira
authors.initials: I
authors.lastname: Lesser
authors.forename: Andrew A
authors.initials: AA
authors.lastname: Nierenberg
authors.forename: Ella
authors.initials: E
authors.lastname: Daly
authors.forename: Benji T
authors.initials: BT
authors.lastname: Kurian
authors.forename: Bradley N
authors.initials: BN
authors.lastname: Gaynes
authors.forename: G K
authors.initials: GK
authors.lastname: Balasubramani
authors.forename: A John
authors.initials: AJ
authors.lastname: Rush
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D018687:Antidepressive Agents, Second-Generation / Q000008:administration & dosage / Q000627:therapeutic use; D016642:Bupropion / Q000008:administration & dosage / Q000627:therapeutic use; D015283:Citalopram / Q000627:therapeutic use; D003511:Cyclohexanols / Q000008:administration & dosage / Q000627:therapeutic use; D003692:Delayed-Action Preparations; D003863:Depression / Q000188:drug therapy / Q000523:psychology*; D004359:Drug Therapy, Combination; D004526:Efficiency; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011569:Psychiatric Status Rating Scales; D017367:Selective Serotonin Reuptake Inhibitors / Q000627:therapeutic use; D020280:Sertraline / Q000627:therapeutic use; D012720:Severity of Illness Index; D016896:Treatment Outcome; D000069470:Venlafaxine Hydrochloride; D014937:Work / Q000523:psychology*; D055815:Young Adult
chemical_list: D018687:Antidepressive Agents, Second-Generation; D016642:Bupropion; D015283:Citalopram; D003511:Cyclohexanols; D003692:Delayed-Action Preparations; D017367:Selective Serotonin Reuptake Inhibitors; D020280:Sertraline; D000069470:Venlafaxine Hydrochloride