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 requirement that symptomsresult in significant clinical distress or impairment. This criterion is difficult to assess and isoften overlooked. This study examines the use of the Sheehan Disability Scale as a possible method ofassessing impairment, as well as the relationship between functioning and discontinuation of antidepressantmedication. Method: Patients (N = 272) receiving antidepressant therapy due to an episodeof major depressive disorder were asked to complete an antidepressant compliance questionnaire. Patientswere telephoned monthly while they continued on antidepressant therapy, up to 6 months. Duringeach call, the Sheehan Disability Scale was administered. Results: Of patients referred to thisstudy, 94.8% met DSM-IV criteria of at least 5 symptoms of major depressive disorder. Most patientshad initial scores ranging from 5 to 8 on all 3 Sheehan disability subscales (occupational, social, andfamily functioning); 72% of patients had at least moderate impairment (scores ≥ 4) on all 3 subscales.After 8 weeks of treatment, 42% of patients had scores < 4 on all 3 subscales (recovery); after 24weeks, 64% of patients had scores < 4 on all 3 subscales. Dropout risk in men was related to improvementin occupational, social, and family functioning, whereas dropout risk in women was related onlyto improvement in family functioning. Conclusion: The Sheehan Disability Scale can be valuable in assessing impairment and thus in correctly diagnosing major depressive disorder. We suggest thatscores of 4 or more (moderate impairment) on all 3 subscales indicate sufficient impairment for astrict diagnosis of major depressive disorder. Functional symptoms continued to improve for up to 24weeks on antidepressant therapy, suggesting 6 months or more of therapy is necessary for maximumfunctional improvement. Premature discontinuation of antidepressant therapy is more likely to occurin women who experience significant improvement in family functioning or men who experience significantimprovement in any functional area.