title: Effects of combined pharmacotherapy and psychotherapy for improving work functioning in major depressive disorder.
abstract: BACKGROUND
  Major depressive disorder is associated with significant impairment in occupational functioning and reduced productivity, which represents a large part of the overall burden of depression.
  
  
  OBJECTIVE
  To examine symptom-based and work functioning outcomes with combined pharmacotherapy and psychotherapy treatment of major depressive disorder.
  
  
  METHODS
  Employed patients with a DSM-IV diagnosis of major depressive disorder were treated with escitalopram 10-20 mg/day and randomised to: (a) telephone-administered cognitive-behavioural therapy (telephone CBT) (n = 48); or (b) adherence-reminder telephone calls (n = 51). Outcomes included the Montgomery-Åsberg Depression Rating Scale (MADRS), administered by masked evaluators via telephone, and self-rated work functioning scales completed online. (Registered at clinicaltrials.gov: NCT00702598.)
  
  
  RESULTS
  After 12 weeks, there were no significant between-group differences in change in MADRS score or in response/remission rates. However, participants in the telephone-CBT group had significantly greater improvement on some measures of work functioning than the escitalopram-alone group.
  
  
  CONCLUSIONS
  Combined treatment with escitalopram and telephone-administered CBT significantly improved some self-reported work functioning outcomes, but not symptom-based outcomes, compared with escitalopram alone.
authors.affiliation: Raymond W. Lam, MD, Department of Psychiatry, University of British Columbia, UBC Hospital, Vancouver, British Columbia; Sagar V. Parikh, MD, Department of Psychiatry, University of Toronto, University Health Network, Toronto, Ontario; Rajamannar Ramasubbu, MD, Department of Psychiatry, University of Calgary, Calgary, Alberta; Erin E. Michalak, PhD, Edwin M. Tam, MD, Auby Axler, MD, Lakshmi N. Yatham, MBBS, Department of Psychiatry, University of British Columbia, UBC Hospital, Vancouver, British Columbia; Sidney H. Kennedy, MD, Department of Psychiatry, University of Toronto, University Health Network, Toronto, Ontario; Chinnapalli V. Manjunath, MD, Department of Psychiatry, University of British Columbia, Surrey Memorial Hospital, Surrey, British Columbia, Canada.
authors.forename: Raymond W
authors.initials: RW
authors.lastname: Lam
authors.forename: Sagar V
authors.initials: SV
authors.lastname: Parikh
authors.forename: Rajamannar
authors.initials: R
authors.lastname: Ramasubbu
authors.forename: Erin E
authors.initials: EE
authors.lastname: Michalak
authors.forename: Edwin M
authors.initials: EM
authors.lastname: Tam
authors.forename: Auby
authors.initials: A
authors.lastname: Axler
authors.forename: Lakshmi N
authors.initials: LN
authors.lastname: Yatham
authors.forename: Sidney H
authors.initials: SH
authors.lastname: Kennedy
authors.forename: Chinnapalli V
authors.initials: CV
authors.lastname: Manjunath
mesh_terms: D000328:Adult; D000368:Aged; D015283:Citalopram / Q000008:administration & dosage / Q000627:therapeutic use*; D015928:Cognitive Behavioral Therapy / Q000379:methods*; D003131:Combined Modality Therapy / Q000379:methods; D003865:Major Depressive Disorder / Q000188:drug therapy / Q000628:therapy*; D004651:Employment / Q000523:psychology / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D057194:Intention to Treat Analysis; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care / Q000706:statistics & numerical data; D011569:Psychiatric Status Rating Scales; D057566:Self Report; D017367:Selective Serotonin Reuptake Inhibitors / Q000008:administration & dosage / Q000627:therapeutic use*; D017216:Telemedicine; D055815:Young Adult
chemical_list: D015283:Citalopram; D017367:Selective Serotonin Reuptake Inhibitors