Review articleRestoring function in major depressive disorder: A systematic review

- Functional impairment in depression increases disability and economic burden.
- Residual functional impairments increase risk of depressive relapse or recurrence.
- Early and effective antidepressant treatment may improve functional impairment.
- Research to optimize early antidepressant treatment and functional recovery is needed.

BackgroundFunctional impairment contributes to significant disability and economic burden in major depressive disorder (MDD). Treatment response is measured by improvement in depressive symptoms, but functional improvement often lags behind symptomatic improvement. Residual deficits are associated with relapse of depressive symptoms.MethodsA literature search was conducted using the following terms: “major depressive disorder,” “functional impairment,” “functional outcomes,” “recovery of function,” “treatment outcome,” “outcome assessment,” “social functioning,” “presenteeism,” “absenteeism,” “psychiatric status rating scales,” and “quality of life.” Search limits included publication date (January 1, 1995 to August 31, 2016), English language, and human clinical trials. Controlled, acute-phase, nonrecurrent MDD treatment studies in adults were included if a functional outcome was measured at baseline and endpoint.ResultsThe qualitative analysis included 35 controlled studies. The Sheehan Disability Scale was the most commonly used functional assessment. Antidepressant treatments significantly improved functional outcomes. Early treatment response predicted functional improvement, while baseline disease severity did not.LimitationsClinical studies utilized various methodologies and assessments for functional impairment, and were not standardized or adequately powered.ConclusionsThe lack of synchronicity between symptomatic and functional improvement highlights an unmet need for MDD. Treatment guided by routine monitoring of symptoms and functionality may minimize residual functional impairments.