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Child Psychiatrist /Adult Psychiatrist

Antidepressants Have Modest Effect on Social Functioning Among Patients With MDD

Updated: Jun 17

Treatment with antidepressants results in a modest improvement in social functioning for patients with MDD.


Antidepressants are associated with a small, but significant, improvement in social functioning (SF) for patients with major depressive disorder (MDD), as described in a systematic review and meta-analysis published in Psychotherapy and Psychosomatics.

Pros and cons of antidepressants

Many psychiatric disorders are associated with reduced sociability, which greatly impacts quality of life. Normative SF majorly contributes to a healthy life and well-being, and as such, is an important outcome in the treatment of psychiatric disorders.


To evaluate the existing body of evidence regarding antidepressants and SF, investigators from the University of Cologne, Cologne, Germany, searched publication databases for relevant studies published through December 2022. The investigators selected a total of 39 publications covering 40 randomized controlled trials (RCTs) that investigated the efficacy of antidepressants compared with placebo for the treatment of MDD and measured SF as an outcome.


The studies were published between 1995 and 2020 and were designed to evaluate primary depression (RCTs=27) or comorbid depression (k=13). The most common instruments for assessing SF were the Short Form Health Survey (SF-36), Social Role Functioning subsection; the Social Adaptation Self-Evaluation Scale (SASS); Work and Social Adjustment Scale (WSAS); and Activities of Daily Living for Mild Cognitive Impairment, Activities of Daily Living Scale (ADCS-ADL).


"Since fulfilling social obligations is of enormous importance to patients, the field needs to increase its efforts in finding means beyond antidepressant drugs to help our patients live a successful social life."


Across all studies analyzed, a total of 10,537 patients were randomly assigned to receive antidepressants and 6049 received placebo. The study participants were aged 46.8 years, on average, and 64.2% were women.


In their meta-analysis, the investigators found a significant effect of antidepressants on SF relative to placebo for both primary (standardized mean difference [SMD], 0.25; 95% CI, 0.21-0.30; I2, 39%; P =.02) and comorbid (SMD, 0.24; 95% CI, 0.10-0.37; I2, 75%; P <.001) depression.


When studies were stratified by risk for bias, the SMD of antidepressants on SF among patients with primary depression was 0.32 (95% CI, 0.24-0.40; I2, 35%) among studies with low risk for bias, compared with 0.23 (95% CI, 0.18-0.28; I2, 27%) for studies with high or uncertain risk for bias. Conversely, for comorbid depression, the SMD of antidepressants on SF did not have an effect in studies with low risk for bias 0.04 (95% CI, -0.16 to 0.24; I2, 0%) compared with 0.29 (95% CI, 0.13-0.44; I2, 79%) for studies with high or uncertain risk for bias.


Notably, antidepressants’ impact on SF was correlated with improvements in depression (r =0.67; P <.001) and quality of life (r =0.63; P <.001). The investigators posit that this association suggests a construct overlap or redundancy in the measurement of these factors. Study authors concluded, “Since fulfilling social obligations is of enormous importance to patients, the field needs to increase its efforts in finding means beyond antidepressant drugs to help our patients live a successful social life.”


This analysis may be limited by the stratification of studies by primary or comorbid depression status, which was a deviation from the original study design protocol.


References:

Kremer S, Wiesinger T, Bschor T, Baethge C. Antidepressants and social functioning in patients with major depressive disorder: systematic review and meta-analysis of double-blind, placebo-controlled RCTs.


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