title: Do social functioning and symptoms improve with continuation antidepressant treatment of persistent depressive disorder? An observational study.
abstract: To determine efficacy of continued treatment with the serotonin norepinephrine reuptake inhibitor duloxetine on symptom reduction and functional improvement in outpatients with dysthymia.
  
  
  
  Fifty outpatients with DSM-IV-TR diagnosed dysthymia who had participated in a 10 week double-blind, placebo-controlled study of duloxetine received open treatment for three months. Nineteen duloxetine responders continued duloxetine, 24 patients initially treated with placebo started open duloxetine treatment, and 7 duloxetine non-responders were treated with desvenlafaxine or bupropion, selected by clinician choice.
  
  
  
  Patients continuing duloxetine maintained symptom improvement, 84% meeting response and 63% remission criteria at week 22. Patients initially treated with placebo showed similarly high levels of response (83%) and remission (62%) at week 22, and most duloxetine non-responders subsequently responded to other antidepressants. Duloxetine-continuation patients improved modestly between weeks 10 and 22 on measures of social and cognitive functioning and temperament. Despite this improvement concurrently across several functional domains, 66.7% of patients continuing duloxetine remained in the impaired range of functioning according to the Social Adjustment Scale (SAS).
  
  
  
  Continued duloxetine treatment appears to be effective in maintaining symptom response in dysthymic disorder, and has positive effects on social functioning. However, the majority of patients do not show normalization of functioning, even when controlling for remission status. Additional treatments should be considered to target residual impairments in social functioning in mood remitted patients with persistent depressive disorder.
authors.affiliation: New York State Psychiatric Institute, New York, NY, USA; Columbia University College of Physicians and Surgeons, New York, NY, USA. Electronic address: hellers@nyspi.columbia.edu.
authors.forename: David J
authors.initials: DJ
authors.lastname: Hellerstein
authors.affiliation: New York Presbyterian Hospital, Weill Cornell Medicine, New York, NY, USA.
authors.forename: Kallio
authors.initials: K
authors.lastname: Hunnicutt-Ferguson
authors.affiliation: New York State Psychiatric Institute, New York, NY, USA; Columbia University College of Physicians and Surgeons, New York, NY, USA.
authors.forename: Jonathan W
authors.initials: JW
authors.lastname: Stewart
authors.affiliation: New York State Psychiatric Institute, New York, NY, USA; Columbia University College of Physicians and Surgeons, New York, NY, USA.
authors.forename: Patrick J
authors.initials: PJ
authors.lastname: McGrath
authors.affiliation: New York State Psychiatric Institute, New York, NY, USA.
authors.forename: Samantha
authors.initials: S
authors.lastname: Keller
authors.affiliation: Institute for the Developing Mind, Children's Hospital Los Angeles; and the Keck School of Medicine, University of Southern California, Los Angeles, CA, USA.
authors.forename: Bradley S
authors.initials: BS
authors.lastname: Peterson
authors.affiliation: New York State Psychiatric Institute, New York, NY, USA; Columbia University College of Physicians and Surgeons, New York, NY, USA.
authors.forename: Ying
authors.initials: Y
authors.lastname: Chen
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D000928:Antidepressive Agents / Q000627:therapeutic use; D003071:Cognition / Q000187:drug effects; D004305:Dose-Response Relationship, Drug; D004311:Double-Blind Method; D004334:Drug Administration Schedule; D000068736:Duloxetine Hydrochloride / Q000627:therapeutic use; D019263:Dysthymic Disorder / Q000188:drug therapy / Q000523:psychology; D000068760:Serotonin and Noradrenaline Reuptake Inhibitors / Q000627:therapeutic use; D012917:Social Adjustment; D012919:Social Behavior; D013694:Temperament / Q000187:drug effects
chemical_list: D000928:Antidepressive Agents; D000068736:Duloxetine Hydrochloride; D000068760:Serotonin and Noradrenaline Reuptake Inhibitors
keywords: Duloxetine; Dysthymic disorder; Maintenance treatment; Persistent depressive disorder; Psychopharmacology; Psychosocial functioning; Serotonin norepinephrine reuptake inhibitor