Social and vocational functioning in chronic depression

Abstract

Anti-depressants have been shown to effectively treat chronic depression. Less is known about treatment effects on psychosocial functioning. The current study examined psychosocial functioning in an outpatient sample of 635 chronic major depressives and double depressives who received 12 weeks of acute double-blind treatment with imipramine or sertraline. Treatment responders received an additional 16 weeks of continuation treatment with active medication and were then randomized to placebo or active medication maintenance treatment for up to 76 weeks.;As hypothesized, patients had significant and pervasive psychosocial impairments at treatment baseline and these impairments correlated with depression severity. Superior psychosocial functioning at baseline was a good predictor of treatment response. By the end of acute treatment, patients had significant improvements in psychosocial functioning as measured by both self-reports and clinician-rated measures.;Although patients who completed maintenance treatment without recurrence or relapse did not demonstrate significant additional improvements in psychosocial functioning over the maintenance phase, they maintained acute phase gains, and their functioning approached or equalled that of normal controls.;Exploratory analyses of the relationship between gender and chronic depression showed that female subjects were significantly younger, more likely to be single, and more depressed than the males who presented for treatment. Diagnoses of chronic major depression and double depression were evenly distributed for women, while men were significantly more likely to be diagnosed with double depression. Females rated themselves as more impaired in the areas of family and marriage and men tended to rate themselves as more impaired at work.;There were no significant differences between chronic major depressives and double depressives with one exception: Significantly more double depressives were gainfully employed than chronic depressives.;The substantial improvement in psychosocial functioning after 12 weeks of acute treatment implies that for treatment responders psychosocial impairments are states and not traits. This lends credence to the classification of chronic depression as a mood disorder as opposed to a personality disorder or neurosis as previously classified. This also indicates the presence of two groups; treatment responders and treatment nonresponders, similar to Akiskal et al.'s (1980) distinction between "subaffective dysthymias" and "character spectrum disorder."