Effects of Antidepressant Treatment on the Quality of Daily Life: An Experience Sampling Study. [CME]
J Clin Psychiatry 2002;63(6):477-485
© Copyright 2014 Physicians Postgraduate Press, Inc.
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Background: Although some depression
trials have included quality of life (QoL) as an
outcome measure, assessments were retrospective and
relatively infrequent. Because QoL varies in
relation to everyday experience, intensive
time-sampling approaches may be useful.
Method: The experience sampling
method (ESM) was used to assess effects of
antidepressant treatment on the quality of life, as
measured from moment to moment in daily life
(mQoL), and related aspects of daily experience.
Primary care patients with a DSM-III-R/DSM-IV
diagnosis of major depressive disorder were
randomly assigned to imipramine (N=32) or placebo (N=31) treatment for 6 weeks, with
possible prolongation to 18 weeks. A healthy
control group (N=22) provided normative data.
Results: Treatment-related increases in
frequency and severity of physical complaints, including those not reported to the general
practitioner as side effects, were associated with
lowered mQoL; this negative association was
especially strong in treatment dropouts. Despite
greater clinical improvement at week 6, imipramine
patients did not report greater increases than placebo patients in mean mQoL ratings.
However, imipramine treatment stabilized mQoL
fluctuations and led to reductions in time spent
"doing nothing." Patients' decisions to prolong
treatment depended on clinical improvement, mQoL changes, and specific early side effects. At
18 weeks, remitted patients still showed deficits
on ESM daily life measures relative to healthy controls, even though QoL had returned to normal
on retrospective measures.
Conclusion: ESM provides new insights
in the effects of antidepressant treatment on
daily life experiences and should therefore be
considered as a supplement to conventional
instruments in clinical trials.