title: Early Improvement in Work Productivity Predicts Future Clinical Course in Depressed Outpatients: Findings From the CO-MED Trial.
abstract: OBJECTIVE
  Depression symptom severity, the most commonly studied outcome in antidepressant treatment trials, accounts for only a small portion of burden related to major depression. While lost work productivity is the biggest contributor to depression's economic burden, few studies have systematically evaluated the independent effect of treatment on work productivity and the relationship between changes in work productivity and longer-term clinical course.
  
  
  METHODS
  Work productivity was measured repeatedly by the Work Productivity and Activity Impairment self-report questionnaire in 331 employed participants with major depression enrolled in the Combining Medications to Enhance Depression Outcomes trial. Trajectories of change in work productivity during the first 6 weeks of treatment were identified and used to predict remission at 3 and 7 months.
  
  
  RESULTS
  Participants reported reduced absence from work and increased work productivity with antidepressant treatment even after controlling for changes in depression severity. Three distinct trajectories of changes in work productivity were identified: 1) robust early improvement (24%), 2) minimal change (49%), and 3) high-impairment slight reduction (27%). Compared with other participants, those with robust improvement had 3-5 times higher remission rates at 3 months and 2-5 times higher remission rates at 7 months, even after controlling for select baseline variables and remission status at week 6.
  
  
  CONCLUSIONS
  In this secondary analysis, self-reported work productivity improved in depressed patients with antidepressant treatment even after accounting for depressive symptom reduction. Early improvement in work productivity is associated with much higher remission rates after 3 and 7 months of treatment.
authors: From the Departments of Psychiatry and Clinical Sciences, University of Texas Southwestern Medical Center, Dallas; and the National University of Singapore, Singapore.
authors: Manish K
authors: MK
authors: Jha
authors: From the Departments of Psychiatry and Clinical Sciences, University of Texas Southwestern Medical Center, Dallas; and the National University of Singapore, Singapore.
authors: Abu
authors: A
authors: Minhajuddin
authors: From the Departments of Psychiatry and Clinical Sciences, University of Texas Southwestern Medical Center, Dallas; and the National University of Singapore, Singapore.
authors: Tracy L
authors: TL
authors: Greer
authors: From the Departments of Psychiatry and Clinical Sciences, University of Texas Southwestern Medical Center, Dallas; and the National University of Singapore, Singapore.
authors: Thomas
authors: T
authors: Carmody
authors: From the Departments of Psychiatry and Clinical Sciences, University of Texas Southwestern Medical Center, Dallas; and the National University of Singapore, Singapore.
authors: A John
authors: AJ
authors: Rush
authors: From the Departments of Psychiatry and Clinical Sciences, University of Texas Southwestern Medical Center, Dallas; and the National University of Singapore, Singapore.
authors: Madhukar H
authors: MH
authors: Trivedi
mesh_terms: D000328:Adult; D000928:Antidepressive Agents / Q000627:therapeutic use; D003865:Major Depressive Disorder / Q000188:drug therapy* / Q000523:psychology*; D004359:Drug Therapy, Combination; D004526:Efficiency; D005260:Female; D006801:Humans; D008297:Male; D011379:Prognosis; D012074:Remission Induction; D055815:Young Adult
chemical_list: D000928:Antidepressive Agents