title: Restoring function in major depressive disorder: A systematic review.
abstract: Functional impairment contributes to significant disability and economic burden in major depressive disorder (MDD). Treatment response is measured by improvement in depressive symptoms, but functional improvement often lags behind symptomatic improvement. Residual deficits are associated with relapse of depressive symptoms.
  
  
  
  A literature search was conducted using the following terms: "major depressive disorder," "functional impairment," "functional outcomes," "recovery of function," "treatment outcome," "outcome assessment," "social functioning," "presenteeism," "absenteeism," "psychiatric status rating scales," and "quality of life." Search limits included publication date (January 1, 1995 to August 31, 2016), English language, and human clinical trials. Controlled, acute-phase, nonrecurrent MDD treatment studies in adults were included if a functional outcome was measured at baseline and endpoint.
  
  
  
  The qualitative analysis included 35 controlled studies. The Sheehan Disability Scale was the most commonly used functional assessment. Antidepressant treatments significantly improved functional outcomes. Early treatment response predicted functional improvement, while baseline disease severity did not.
  
  
  
  Clinical studies utilized various methodologies and assessments for functional impairment, and were not standardized or adequately powered.
  
  
  
  The lack of synchronicity between symptomatic and functional improvement highlights an unmet need for MDD. Treatment guided by routine monitoring of symptoms and functionality may minimize residual functional impairments.
authors.affiliation: University of South Florida College of Medicine, Tampa, FL, USA. Electronic address: dsheehan@health.usf.edu.
authors.forename: David V
authors.initials: DV
authors.lastname: Sheehan
authors.affiliation: National Center of Neurology and Psychiatry, Tokyo, Japan.
authors.forename: Kazuyuki
authors.initials: K
authors.lastname: Nakagome
authors.affiliation: Pfizer Japan Inc, Tokyo, Japan.
authors.forename: Yuko
authors.initials: Y
authors.lastname: Asami
authors.affiliation: Pfizer Inc, New York, NY, USA.
authors.forename: Elizabeth A
authors.initials: EA
authors.lastname: Pappadopulos
authors.affiliation: Pfizer Canada Inc. Kirkland, Quebec, Canada.
authors.forename: Matthieu
authors.initials: M
authors.lastname: Boucher
mesh_terms: D000928:Antidepressive Agents / Q000627:therapeutic use; D003865:Major Depressive Disorder / Q000523:psychology* / Q000628:therapy*; D006801:Humans; D011569:Psychiatric Status Rating Scales; D011597:Psychomotor Performance; D011788:Quality of Life; D020127:Recovery of Function
chemical_list: D000928:Antidepressive Agents
keywords: Functional Impairment; Functional Remission; Major Depressive Disorder; Quality of Life; Social Impairment; Work Performance