Advances in the Management of Major Depressive Disorder - Episode 7

Improvement in Quality of Life and Function in Patients with Major Depressive Disorder

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The expert psychiatrists discuss when to evaluate treatment efficacy and the impact of patients’ quality of life and function in such evaluations.


The clinicians emphasize that not seeing improvement in depression symptoms within 2 weeks of starting or changing treatment predicts very low likelihood of eventual response. Studies show that making a change at 2 weeks leads to better outcomes compared to waiting months.

They liken this to not letting glucose stay dangerously high for months in diabetes or letting cancer linger untreated. Particularly with students or working-age patients, 2 weeks versus 2 months can mean the difference between finishing a semester or losing a job.

Too often both patients and clinicians accept "good enough" results with lingering symptoms and impairment. We must apply the same urgency and standards to depression as other illnesses. With PHQ-9 scores now in EMRs, clinicians can easily monitor between visits rather than waiting months to evaluate.

Lack of efficacy or side effects are clear reasons to adjust treatment, but residual symptoms like anhedonia or concentration impairment are also important treatment targets as they predict recurrence and dysfunction. Symptoms may partially improve but quality of life and function often lag behind.

The clinicians are encouraged that novel mechanisms like dextromethorphan-bupropion not only demonstrate rapid symptom improvement in line with their glutamatergic effects, but also early signals of improved functioning. This elevates the agent in their treatment algorithms and offers more comprehensive relief enabling patients to thrive, not just survive.

This summary was AI-generated and edited for clarity and readability.