Depression 07 Nov, 2024 Read Time: 5 mins

Functioning As A Treatment Goal In Major Depressive Disorder (MDD)

Bridging the Gap: Aligning Treatment Goals in Major Depressive Disorder to Enhance Functional Recovery

 

Major Depressive Disorder extends far beyond mere sadness or low mood. It is a complex condition encompassing three distinct symptom domains: emotional (including sadness, anhedonia, anxiety, lack of motivation, and hopelessness, among others), physical, and cognitive, all of which can significantly impair daily functioning. Seven out of 10 patients have severe functional impairment at diagnosis (1). This heterogeneity of the disease leads to diverse treatment goals, varying between patients and healthcare professionals. Dr. Sherif Othman, Consultant Psychiatrist and Chief of the Neuropsychiatry Department at Almoosa Specialist Hospital, discussed this topic in The 17th International Conference on Psychiatry (ICP-SGH)

A Discordance in Psychiatry Clinics

Patients with major depressive disorder (MDD) and their physicians often hold differing views on treatment priorities. When asked to select their hope from the treatment, patients mostly reported functional goals, prioritizing returning to their normal family, social, and working life; while physicians preferred to focus on lifting mood and alleviating depressive symptoms only (2,3).

 

Underlying Reasons

This divergence arises from a different way of perceiving MDD symptoms among patients and physicians. Healthcare professionals (HCPs) may underestimate the impact of emotional blunting and anhedonia – which significantly impact daily functioning – in MDD patients (4).

 

The Importance of Aligning Goals

Patients need to feel that their treatment is relevant and meaningful to their goals. Focusing on patients’ goals can help them achieve this mindset, improve their adherence to medications, and avoid psychotherapy drop-out; while ultimately improving engagement in care (5).

 

Functional Improvement as a Goal in Clinical Practice Guidelines

The short-term initial focus of treatment should be to get patients to be well by alleviating their depressive symptoms and restoring their functioning, while the long-term maintenance management should aim to keep the patients well by allowing them to return to their full functioning and quality of life, while preventing recurrence (6). HCPs should understand that mere remission of depressive symptoms does not mean full functional recovery (7). Numerous guidelines highlight that a key goal of treatment is to restore patients’ prior level of functioning (6,8,9).

 

Mitigation

To bridge this gap in treatment goals, physicians should aim to routinely evaluate patients with validated scales for symptoms, functioning, and quality of life, so that they are able to develop a treatment plan that better suits the needs of the patient. Physicians should also routinely evaluate their patients’ progress and treatment goal attainment. Shared decision-making between physicians and patients is also recommended by clinical practice guidelines for MDD.

Emotional blunting and anhedonia are among the symptoms that negatively affect functioning in patients with MDD (10–12). Vortioxetine brings a competitive edge over other antidepressants by offering serotonin receptor activity modulation and inhibition, thereby alleviating depressive symptoms, anhedonia, and functioning (13).

 

Our correspondent’s highlights from the symposium are meant as a fair representation of the scientific content presented. The views and opinions expressed on this page do not necessarily reflect those of Lundbeck.

References

1.         Fried EI, Nesse RM. The Impact of Individual Depressive Symptoms on Impairment of Psychosocial Functioning. Gong Q, editor. PLoS One [Internet]. 2014 Feb 28;9(2):e90311. Available from: https://dx.plos.org/10.1371/journal.pone.0090311

2.         Baune BT, Christensen MC. Differences in Perceptions of Major Depressive Disorder Symptoms and Treatment Priorities Between Patients and Health Care Providers Across the Acute, Post-Acute, and Remission Phases of Depression. Front Psychiatry [Internet]. 2019 May 21;10(MAY):1–10. Available from: https://www.frontiersin.org/article/10.3389/fpsyt.2019.00335/full

3.         Demyttenaere K, Donneau AF, Albert A, Ansseau M, Constant E, van Heeringen K. What is important in being cured from depression? Discordance between physicians and patients (1). J Affect Disord [Internet]. 2015 Mar;174:390–6. Available from: https://linkinghub.elsevier.com/retrieve/pii/S0165032714007897

4.         Christensen MC, Ren H, Fagiolini A. Emotional blunting in patients with depression. Part I: clinical characteristics. Ann Gen Psychiatry [Internet]. 2022 Dec 4;21(1):10. Available from: https://annals-general-psychiatry.biomedcentral.com/articles/10.1186/s1…

5.         Battle CL, Uebelacker L, Friedman MA, Cardemil E V., Beevers CG, Miller IW. Treatment Goals of Depressed Outpatients. J Psychiatr Pract [Internet]. 2010 Nov;16(6):425–30. Available from: https://journals.lww.com/00131746-201011000-00009

6.         Lam RW, Kennedy SH, Parikh S V., MacQueen GM, Milev R V., Ravindran A V. Canadian Network for Mood and Anxiety Treatments (CANMAT) 2016 Clinical Guidelines for the Management of Adults with Major Depressive Disorder. Can J Psychiatry [Internet]. 2016 Sep 11;61(9):506–9. Available from: https://journals.sagepub.com/doi/10.1177/0706743716659061

7.         Yang H, Gao S, Li J, Yu H, Xu J, Lin C, et al. Remission of symptoms is not equal to functional recovery: Psychosocial functioning impairment in major depression. Front Psychiatry [Internet]. 2022 Jul 26;13. Available from: https://www.frontiersin.org/articles/10.3389/fpsyt.2022.915689/full

8.         Malhi GS, Bell E, Bassett D, Boyce P, Bryant R, Hazell P, et al. The 2020 Royal Australian and New Zealand College of Psychiatrists clinical practice guidelines for mood disorders. Aust New Zeal J Psychiatry [Internet]. 2021 Jan 22;55(1):7–117. Available from: https://journals.sagepub.com/doi/10.1177/0004867420979353

9.         American Psychiatric Association. Practice guideline for the treatment of patiets with major depressive disorder. Third edit. Arlington, VA; 2010. 1–152 p.

10.       Rosenblat JD, Simon GE, Sachs GS, Deetz I, Doederlein A, DePeralta D, et al. Treatment effectiveness and tolerability outcomes that are most important to individuals with bipolar and unipolar depression. J Affect Disord [Internet]. 2019 Jan;243:116–20. Available from: https://linkinghub.elsevier.com/retrieve/pii/S0165032718310164

11.       Vinckier F, Gourion D, Mouchabac S. Anhedonia predicts poor psychosocial functioning: Results from a large cohort of patients treated for major depressive disorder by general practitioners. Eur Psychiatry [Internet]. 2017 Jul 23;44:1–8. Available from: https://www.cambridge.org/core/product/identifier/S0924933800069716/typ…

12.       Kupferberg A, Bicks L, Hasler G. Social functioning in major depressive disorder. Neurosci Biobehav Rev [Internet]. 2016 Oct;69:313–32. Available from: https://linkinghub.elsevier.com/retrieve/pii/S0149763415302487

13.       Guilloux JP, Mendez-David I, Pehrson A, Guiard BP, Repérant C, Orvoën S, et al. Antidepressant and anxiolytic potential of the multimodal antidepressant vortioxetine (Lu AA21004) assessed by behavioural and neurogenesis outcomes in mice. Neuropharmacology [Internet]. 2013 Oct;73:147–59. Available from: https://linkinghub.elsevier.com/retrieve/pii/S0028390813002244