title: Quality of Life and Functioning in Comorbid Posttraumatic Stress Disorder and Major Depressive Disorder After Treatment With Citalopram Monotherapy.
abstract: OBJECTIVE
  Posttraumatic stress disorder (PTSD) and major depressive disorder (MDD) often have high comorbidity, consequently influencing patient-reported outcomes of depressive symptom severity, quality of life (QOL), and functioning. We hypothesized that the combined effects of concurrent PTSD and MDD would result in worse treatment outcomes, whereas individuals who achieved MDD remission would have better treatment outcomes.
  
  
  METHODS
  We analyzed 2280 adult participants who received level 1 treatment (citalopram monotherapy) in the Sequenced Treatment Alternatives to Relieve Depression study, including 2158 participants with MDD without comorbid PTSD and 122 participants with MDD with comorbid PTSD (MDD + PTSD). Post hoc analysis examined the proportion of participants whose scores were within normal or severely impaired for functioning and QOL. Remission status at exit from MDD was also determined.
  
  
  RESULTS
  At entry, participants with MDD + PTSD experienced significantly worse QOL, functioning, and depressive symptom severity compared with participants with MDD without comorbid PTSD. Although both groups had significant improvements in functioning and QOL posttreatment, the participants with MDD + PTSD were less likely to achieve remission from MDD.
  
  
  CONCLUSIONS
  Findings suggested that participants with MDD + PTSD are at a greater risk for severe impairment across all domains and less likely to achieve remission from MDD after treatment with citalopram monotherapy. As such, the use of patient-reported measures of QOL and functioning may inform practicing clinicians' and clinical trial researchers' abilities to develop appropriate interventions and monitor treatment efficacy. More importantly, we encourage clinicians and health care providers to routinely screen for PTSD in patients with MDD because this at-risk group requires tailored and specific pharmacotherapy and psychotherapy interventions beyond traditionally standard treatments for depression.
authors.affiliation: *Department of Psychiatry and Behavioral Neurosciences, Cedars-Sinai Medical Center; †Department of Psychology, California School of Professional Psychology at Alliant International University; ‡Biostatistics Core, Research Institute and Clinical & Translational Science Institute, Cedars-Sinai Medical Center; and §Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, UCLA Medical Center, Los Angeles, CA.
authors.forename: Alexander J
authors.initials: AJ
authors.lastname: Steiner
authors.forename: Nathalie
authors.initials: N
authors.lastname: Boulos
authors.forename: James
authors.initials: J
authors.lastname: Mirocha
authors.forename: Stephanie M
authors.initials: SM
authors.lastname: Wright
authors.forename: Katherine L
authors.initials: KL
authors.lastname: Collison
authors.forename: Waguih W
authors.initials: WW
authors.lastname: IsHak
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D018687:Antidepressive Agents, Second-Generation / Q000627:therapeutic use*; D015283:Citalopram / Q000627:therapeutic use*; D015897:Comorbidity; D003865:Major Depressive Disorder / Q000188:drug therapy / Q000453:epidemiology / Q000523:psychology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011569:Psychiatric Status Rating Scales; D011788:Quality of Life; D012189:Retrospective Studies; D012720:Severity of Illness Index; D013313:Stress Disorders, Post-Traumatic / Q000188:drug therapy / Q000453:epidemiology / Q000523:psychology; D055815:Young Adult
chemical_list: D018687:Antidepressive Agents, Second-Generation; D015283:Citalopram