Quality of life in major depressive disorder before/after multiple steps of treatment and one‐year follow‐up
Open accessAbstract
Objective: This study examines the impact of major depressive disorder (MDD) and its treatment on quality of life (QOL). Method: From the Sequenced Treatment Alternatives to Relieve Depression (STAR*D) trial, we analyzed complete data of 2280 adult MDD out‐patients at entry/exit of each level of antidepressant treatments and after 12 months of entry to follow‐up. QOL was measured using the QOL Enjoyment and Satisfaction Questionnaire (Q‐LES‐Q). The proportions of patients scoring ‘within‐normal’ QOL (within 10% of Q‐LES‐Q community norms) and those with ‘severely impaired’ QOL (>2 SD below Q‐LES‐Q community norms) were analyzed. Results: Before treatment, no more than 3% of MDD patients experienced ‘within‐normal’ QOL. Following treatment, statistically significant improvements were detected; however, the proportion of patients achieving ‘within‐normal’ QOL did not exceed 30%, with >50% of patients experiencing ‘severely impaired’ QOL. Although remitted patients had greater improvements compared with non‐remitters, 32–60% continued to experience reduced QOL. 12‐month follow‐up data revealed that the proportion of patients experiencing ‘within‐normal’ QOL show a statistically significant decrease in non‐remitters. Conclusion: Symptom‐focused treatments of MDD may leave a misleading impression that patients have recovered when, in fact, they may be experiencing ongoing QOL deficits. These findings point to the need for investigating specific interventions to ameliorate QOL in MDD.
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An unintended consequence of a TRD framework that is hierarchical is encouraging multiple unproven treatment strategies, with polypharmacy and the possibility of associated safety and tolerability concerns.
“Furthermore, an unintended consequence of a TRD framework that is hierarchical is encouraging mul tiple unproven treatment strategies, with poly pharmacy and the possibility of associated safety and tolerability concerns 70,75 .”
From Treatment‐resistant depression: definition, prevalence, detection, management, and investigational interventions (2023) · cites this paper as [75]
The Methods (Treatments Administered; page not supplied) describe successive STAR*D treatment levels with switching and augmentation, and the Discussion (Limitations and Strengths; page not supplied) notes that medication adverse effects could negatively affect quality of life. The paper does not say that a hierarchical TRD framework encourages unproven strategies or polypharmacy, or link that framework to safety and tolerability concerns. (LLM, conf=0.83)
Experimental — accuracy not yet measuredThe predictive utility of quality of life as a critical outcome measure when defining TRD is underscored by the observation that persons remitting with antidepressants who continue to report decreased quality of life are at greater risk of relapse and recurrence.
“The predictive utility of quality of life as a critical outcome measure when defining TRD is underscored by the observation that persons remitting with antidepressants who continue to report decreased quality of life are at greater risk of relapse and recurrence 74,75 .”
From Treatment‐resistant depression: definition, prevalence, detection, management, and investigational interventions (2023) · cites this paper as [75]
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Experimental — accuracy not yet measuredExisting TRD definitions fail to take into consideration the social, economic, anamnestic and interpersonal factors which, alone or in combinations, are known to moderate antidepressant response.
“Further drawbacks of existing TRD defi nitions are that they fail to take into consid eration the social, economic, anamnestic (e.g., adverse childhood experiences) and interpersonal factors which, alone or in combinations, are known to moderate antidepressant response 1,44,47,71,75- 81 .”
From Treatment‐resistant depression: definition, prevalence, detection, management, and investigational interventions (2023) · cites this paper as [75]
The Introduction (page unavailable) mentions social and economic factors only as correlates of poorer quality of life, not as moderators of antidepressant response. The Treatments Administered section (page unavailable) describes treatment steps but does not assess TRD definitions. Searches for childhood adversity, interpersonal factors, and response moderators found no passage supporting the attributed point. (LLM, conf=0.74)
Experimental — accuracy not yet measuredEach relapse/recurrence is associated with an increased risk of future recurrence, as well as reduced quality-of-life and functioning.
“Each relapse/recurrence is associated with an increased risk of future recurrence, 11 as well as reduced quality-of-life 12 and functioning. 13”
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- Authors
- IsHak, W. W., Mirocha, J., James, D., Tobia, G., Vilhauer, J., Fakhry, H., Pi, S., Hanson, E., Nashawati, R., Peselow, E. D., & Cohen, R. M.
- Affiliations
- Cedars-Sinai Medical Center (US)
- Cairo University (EG)
- Loma Linda University (US)
- University of Southern California (US)
- Richmond University Medical Center (US)
- Emory University (US)
- Corresponding author
- IsHak, W. W.
- ORCID
- IsHak, W. W.
- Venue
- Acta Psychiatrica Scandinavica
- Publisher
- Wiley
- Published
- 2014-06-23
- Volume
- 131
- Issue
- 1
- Pages
- 51-60
- ISSN
- 0001-690X (ISSN-L)
- 1600-0447
- PMC
- PMC4267902
- OpenAlex
- W1988690727
- Cited by
- 140
- References
- 57
- Citations by year
- 2026: 7 · 2025: 19 · 2024: 10 · 2023: 17 · 2022: 19 · 2021: 21 · 2020: 9 · 2019: 10 · 2018: 11 · 2017: 4 · 2016: 7 · 2015: 3 · 2014: 2
- FWCI
- 3.88
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Acta Psychiatrica Scandinavica (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Institutes of Health (n01mh90003-26-0-0)
- National Institute of Mental Health (N01 MH090003)
- Topics
- Health Sciences › Medicine › Pharmacology › Treatment of Major Depression
- Social Sciences › Psychology › Social Psychology › Mental Health Treatment and Access
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
- Keywords
- major depressive disorder, quality of life, antidepressant treatment, STAR*D trial, Q-LES-Q, remission, treatment-resistant depression, long-term follow-up, symptomatic treatment
- MeSH terms
- Adolescent, Adult, Aged, Antidepressive Agents, Combined Modality Therapy, Major Depressive Disorder, Female, Follow-Up Studies, Humans, Male, Middle Aged, Psychiatric Status Rating Scales, Quality of Life, Surveys and Questionnaires, Severity of Illness Index, Cognitive Behavioral Therapy, Treatment Outcome, Young Adult
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