Brain Function – Depression

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Functional Consideration in Depression

From Medscape Medical News > Conference News

New Depression Guideline Goes Beyond Symptom Relief

Kate Johnson

October 2, 2012 (Montreal, Canada) — The treatment of major depressive disorder (MDD) should go beyond the goal of symptom relief to include a more global target of improving patients’ overall and occupational functioning.

This shift is reflected in new consensus recommendations currently being finalized by the Canadian Network for Mood and Anxiety Treatments (CANMAT).

“The focus on symptoms doesn’t necessarily make sense for our patients because they’re primarily concerned about their functioning. And so we think we need to move the bar now — raise the bar — in terms of our assessment of outcomes. The ideal outcome really should be functional recovery,” Raymond Lam, MD, executive chair of the network, told delegates attending the Canadian Psychiatric Association (CPA) 62nd Annual Conference.

Studies show that MDD has a significant impact on work functioning, yet roughly 70% of people with MDD remain at work.

“Our view is that unless there are safety issues, it’s better for patients to be trying to stay at work while they’re being treated rather than being off work. The longer they’re off work, the harder it is to get them back,” said Dr. Lam, who is also professor of psychiatry and head of the Mood and Anxiety Disorders Program, University of British Columbia in Vancouver, Canada.

Because “the trajectory and time course of functional improvement may not mirror that of symptom improvement,” treatment that addresses symptoms alone may miss an important part of the picture, he said.

A “Practical Goal”

After attending the presentation, conference delegate Derryck Smith, MD, clinical professor of psychiatry, University of British Columbia, who is also a psychiatrist in private practice in Vancouver, said he agreed with the recommendations.

“We’re trying to get people better, not just get rid of symptoms. We have to work towards a practical goal,” he told Medscape Medical News.

“We need to help make people more successful in their life in general, in their relationships, as well as how they’re doing in their job…and maybe even in the physical aspects — are they back to running, for example? Are they back to their hobbies? Are they doing well socially?

“Even if their symptoms are reduced, you may have to find out why they’re not back at work. Maybe it’s because they’re not sleeping, maybe it’s because they’re having cognitive difficulties,” he said.

He added that the current DSM-IV diagnostic criteria include “a unique cluster of symptoms that defines an illness, but you always have to have functional impairment to make the diagnosis, and it doesn’t define what functional impairment is.”

He said that objective functional outcome measures are much needed for this assessment.

The study and symposium were funded by Lundbeck Canada. Dr. Lam holds the copyright on the LEAPS, but it is free for clinical use. He also disclosed the following relationships: speaker/consulting Honoraria: AstraZeneca, Biovail, Bristol Myers Squibb, CANMAT, Common Drug Review, Eli Lilly, GlaxoSmithKline, Lundbeck, LundbeckInstitute, Mochida, Pfizer, Servier, Takeda; clinical trials/grants: AquaceuticaGroup,AstraZeneca, Bristol Myers Squibb Canadian Institutes of Health Research, Canadian Psychiatric Association Foundation, CANMAT, LundbeckCanada, Litebook Company, Inc, Michael Smith Foundation for Health Research, Pfizer, St. Jude Medical, UBC Institute of Mental Health/Coast Capital Savings. Dr. Smith has disclosed no relevant financial relationships.

Canadian Psychiatric Association (CPA) 62nd Annual Conference. Abstracts Ps5b and S11. Presented September 29, 2012.

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