Compliance with antidepressants in a primary care setting, 2: The influence of gender and type of impairment

Background: DSM-IV diagnosis of major depressive disorder includes a requir ement that symptoms result in significant clinical distress or impairment. This criterion is difficult to assess and is often overlooked. This study e xamines the use of the Sheehan Disability Scale as a possible method of ass essing impairment, as well as the relationship between functioning and disc ontinuation of antidepressant medication. Method: Patients (N = 272) receiv ing antidepressant therapy due to an episode of major depressive disorder w ere asked to complete an antidepressant compliance questionnaire. Patients were telephoned monthly while they continued on antidepressant therapy, up to 6 months. During each call, the Sheehan Disability Scale was administere d. Results: Of patients referred to this study, 94.8% met DSM-IV criteria o f at least 5 symptoms of major depressive disorder. Most patients had initi al scores ranging from 5 to 8 on all 3 Sheehan disability subscales (occupa tional, social, and family functioning); 72% of patients had at least moder ate impairment (scores greater than or equal to 4) on all 3 subscales. Afte r 8 weeks of treatment, 42% of patients had scores < 4 on all 3 subscales ( recovery); after 24 weeks, 64% of patients had scores < 4 on all 3 subscale s. Dropout risk in men was related to improvement in occupational, social, and family functioning, whereas dropout risk in women was related only to i mprovement in family functioning. Conclusion: The Sheehan Disability Scale can be valuable in assessing impairment and thus in correctly diagnosing ma jor depressive disorder. We suggest that scores of 4 or more (moderate impa irment) on all 3 subscales indicate sufficient impairment for a strict diag nosis of major depressive disorder. Functional symptoms continued to improv e for up to 24 weeks on antidepressant therapy, suggesting 6 months or more of therapy is necessary for maximum functional improvement. Premature disc ontinuation of antidepressant therapy is more likely to occur in women who experience significant improvement in family functioning or men who experie nce Significant improvement in any functional area.