COMORBID ANXIOUS SIGNS AND SYMPTOMS IN MAJOR DEPRESSION - IMPACT ON FUNCTIONAL WORK CAPACITY AND COMPARATIVE TREATMENT OUTCOMES

Psychological distress is a driver both of direct and indirect health care costs. Depression compromises functional well-be, such as work pr oductivity. Comorbid anxious features often complicate the recognition of depression and may herald a poor prognosis. We report the results of a cross-sectional naturalistic study to determine the impact of thr ee interventions (no antidepressant, fluoxetine, or tricyclic antidepr essant therapy) on relative risk of work days lost in 454 French outpa tients with either major or minor depression. Most depressed patients also manifested anxious features (76 % with a Hamilton Rating Scale fo r Anxiety score greater-than-or-equal-to 12). The presence of anxiety was related to the severity of depression, work absenteeism, and curre nt social instability. Depression severity (Hamilton Rating Scale for Depression score greater-than-or-equal-to 26, including the contributi ons of anxious symptoms), psychiatric comorbidity, and psychomotor ret ardation best predicted continued work absenteeism. Patients with majo r depression were more likely to receive an antidepressant if they had a past history of depressive episodes and/or previous work disability . Patients with minor depression were less likely to receive drug ther apy than patients with major depression, despite their current work di sability. Among patients who received fluoxetine or a tricyclic antide pressant for at least 8 weeks, fluoxetine was associated with statisti cally significantly lower mean anxiety and depression scores and fewer work days missed.