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Effects of combined pharmacotherapy and psychotherapy for improving work functioning in major depressive disorder

  • Raymond W. Lam (a1), Sagar V. Parikh (a2), Rajamannar Ramasubbu (a3), Erin E. Michalak (a1), Edwin M. Tam (a1), Auby Axler (a1), Lakshmi N. Yatham (a1), Sidney H. Kennedy (a1) and Chinnapalli V. Manjunath (a2)...
Abstract
Background

Major depressive disorder is associated with significant impairment in occupational functioning and reduced productivity, which represents a large part of the overall burden of depression.

Aims

To examine symptom-based and work functioning outcomes with combined pharmacotherapy and psychotherapy treatment of major depressive disorder.

Method

Employed patients with a DSM-IV diagnosis of major depressive disorder were treated with escitalopram 10–20mg/day and randomised to: (a) telephone-administered cognitive-behavioural therapy (telephone CBT) (n = 48); or (b) adherence-reminder telephone calls (n = 51). Outcomes included the Montgomery-åsberg Depression Rating Scale (MADRS), administered by masked evaluators via telephone, and self-rated work functioning scales completed online. (Registered at clinicaltrials.gov: NCT00702598.)

Results

After 12 weeks, there were no significant between-group differences in change in MADRS score or in response/remission rates. However, participants in the telephone-CBT group had significantly greater improvement on some measures of work functioning than the escitalopram-alone group.

Conclusions

Combined treatment with escitalopram and telephone- administered CBT significantly improved some self-reported work functioning outcomes, but not symptom-based outcomes, compared with escitalopram alone.

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Copyright
Corresponding author
Dr Raymond W. Lam, Department of Psychiatry, University of British Columbia, 2255 Wesbrook Mall, Vancouver, BC, V6T 2A1, Canada. Email: r.lam@ubc.ca
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Declaration of interest

R.W.L has received consulting and/or speaker honoraria from: AstraZeneca, Biovail, Eli Lilly, Lundbeck, Lundbeck Institute, Mochida, Pfizer, Servier, and Takeda; and has received research grants from: Aquaceutica, Bristol-Myers Squibb, Litebook Company, Lundbeck, Pfizer, St Jude Medical, and UBC Institute of Mental Health/Coast Capital Savings. S.V.P. has received consulting and/or speaker honoraria from: AstraZeneca, Bristol-Myers-Squibb, Eli Lilly, Lundbeck, and Pfizer; and has received research grants from: Apotex, AstraZeneca, Bristol-Myers-Squibb, Eli Lilly, Lundbeck, Novartis, Pfizer, and Servier; and holds shares in Mensante Corporation. R.R. has received research grants from AstraZeneca. L.N.Y has received consulting and/or speaker honoraria from: Abbott, AstraZeneca, Bristol-Myers Squibb, Eli Lilly, Forest, GlaxoSmithKline, Johnson and Johnson, Novartis, Pfizer, Servier, and Wyeth; and has received research grants from: Janssen, Lundbeck, Otsuka, Ranbaxy. S.H.K. has received consulting and/or speaker honoraria from: AstraZeneca, Boehringer-Ingelheim, Bristol-Meyers Squibb, Brain Cells Inc, Eli Lilly, GlaxoSmithKline, Lundbeck, Pfizer, Servier, and St Jude Medical; and has received research grants from: AstraZeneca, Brain Cells Inc, Lundbeck, Pfizer, Servier, and St Jude Medical. E.E.M. has received consulting honoraria from Lundbeck.

Footnotes
References
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Effects of combined pharmacotherapy and psychotherapy for improving work functioning in major depressive disorder

  • Raymond W. Lam (a1), Sagar V. Parikh (a2), Rajamannar Ramasubbu (a3), Erin E. Michalak (a1), Edwin M. Tam (a1), Auby Axler (a1), Lakshmi N. Yatham (a1), Sidney H. Kennedy (a1) and Chinnapalli V. Manjunath (a2)...
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