Do social functioning and symptoms improve with continuation antidepressant treatment of persistent depressive disorder? An observational study

David J Hellerstein; Kallio Hunnicutt-Ferguson; Jonathan W Stewart; Patrick J McGrath; Samantha Keller; Bradley S Peterson; Ying Chen

doi:10.1016/j.jad.2016.12.026

Do social functioning and symptoms improve with continuation antidepressant treatment of persistent depressive disorder? An observational study

J Affect Disord. 2017 Mar 1:210:258-264. doi: 10.1016/j.jad.2016.12.026. Epub 2016 Dec 20.

Authors

David J Hellerstein¹, Kallio Hunnicutt-Ferguson², Jonathan W Stewart³, Patrick J McGrath³, Samantha Keller⁴, Bradley S Peterson⁵, Ying Chen³

Affiliations

¹ 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.
² New York Presbyterian Hospital, Weill Cornell Medicine, New York, NY, USA.
³ New York State Psychiatric Institute, New York, NY, USA; Columbia University College of Physicians and Surgeons, New York, NY, USA.
⁴ New York State Psychiatric Institute, New York, NY, USA.
⁵ Institute for the Developing Mind, Children's Hospital Los Angeles; and the Keck School of Medicine, University of Southern California, Los Angeles, CA, USA.

PMID: 28064115
DOI: 10.1016/j.jad.2016.12.026

Abstract

Objective: To determine efficacy of continued treatment with the serotonin norepinephrine reuptake inhibitor duloxetine on symptom reduction and functional improvement in outpatients with dysthymia.

Method: 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.

Results: 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).

Conclusions: 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.

Trial registration: ClinicalTrials.gov NCT00360724.

Keywords: Duloxetine; Dysthymic disorder; Maintenance treatment; Persistent depressive disorder; Psychopharmacology; Psychosocial functioning; Serotonin norepinephrine reuptake inhibitor.

Publication types

Controlled Clinical Trial
Observational Study

MeSH terms

Adult
Aged
Antidepressive Agents / therapeutic use*
Cognition / drug effects
Dose-Response Relationship, Drug
Double-Blind Method
Drug Administration Schedule
Duloxetine Hydrochloride / therapeutic use*
Dysthymic Disorder / drug therapy*
Dysthymic Disorder / psychology
Female
Humans
Male
Middle Aged
Serotonin and Noradrenaline Reuptake Inhibitors / therapeutic use*
Social Adjustment
Social Behavior*
Temperament / drug effects

Substances

Antidepressive Agents
Serotonin and Noradrenaline Reuptake Inhibitors
Duloxetine Hydrochloride

Associated data

ClinicalTrials.gov/NCT00360724