Chronic unipolar depression can have a significant negative impact on social and vocational roles and can lead to academic and vocational underachievement. Studies have shown that, despite the chronicity of this illness, short-term treatment with antidepressant medications results in rapid and marked improvement in social and vocational functioning. These studies have concentrated on the short-term benefit of this class of medication. Kocsis and associates measured psychosocial functioning in patients with chronic depression during long-term maintenance antidepressant treatment or following a discontinuation of such treatment.
Patients enrolled in the study had chronic major or double depression. Participants were eligible for the maintenance phase of the study if they achieved and sustained at least a satisfactory antidepressant response during the initial 12-week treatment phase and the 16-week continuation treatment with sertraline. Responders at the end of this phase were randomly assigned to receive 18 months of maintenance therapy with sertraline or placebo. Multiple domains of psychosocial functioning were assessed every two weeks for the first 12 weeks and then monthly.
The placebo group showed a substantial worsening in psychosocial function measurements compared with patients who received sertraline. Patients in both treatment groups who had a reemergence of depression lost all psychosocial gains made during treatment. Patients who stayed in remission during the entire study showed the most improvement in psychosocial functioning during the initial treatment phase. Patients who remained in remission had normalization of functioning by the end of the study in 58 to 84 percent of cases, depending on the outcome measure used.
The authors conclude that long-term treatment of chronic depression can result in substantial improvement in psychosocial functioning. Discontinuation of this treatment results in frequent reemergence of symptoms and loss of psychosocial gain. Most improvement in psychosocial function occurs during the initial treatment phase, but it can be maintained over the long term.