Quality of life

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Abstract
The socioeconomic impact of major depression is considerable, due to poor patient functioning and increased social impairment, bed disability days, and use of health care resources. Major depression and the side effects of antidepressant medication also adversely affect patients' quality of life (QOL). However, few clinical trials of major depression examine QOL as a measure of treatment outcome. A comprehensive, quantitative QOL instrument for depression was recently tested and validated as conforming to accepted psychometric standards. The sertraline quality of life battery (SQOLB) consists of nine domains measuring health perceptions: energy/vitality, cognitive function, social interaction, alertness behavior, work behavior, home management, life satisfaction, and bed disability days. The SQOLB has been used in two open-label trials of sertraline. In the first study, the SQOLB was administered to 400 patients with major depression at baseline and final visit in a 6 week, open-label, general practice study. At endpoint, mean Montgomery-Asberg Depression Rating Scale (MADRS) and Clinical Global Impression (CGI) scores were significantly improved. The QOL battery also showed significant (p < 0.001) positive changes from baseline to final visit in all nine domains measured. In the second study, the SQOLB was used as part of an 8 week, open-label trial of sertraline in 308 UK hospital outpatients being treated for depression by psychiatrists. Sertraline was effective in managing the depression and caused statistically significant improvements (p < 0.001) in all QOL domains measured. The QOL scales give a better indication of the effect of pervasive depressive symptoms on a patient's life than rating scales of depressive symptomatology. Sertraline has been shown to have a positive impact on these parameters and thereby improves the patients' quality of life. An economic construct, the “quality-adjusted life year” (QALY), was developed to study the effects of sertraline in the prevention of recurrent depression. The lifetime treatment course of two cohorts of patients was simulated, one treated with sertraline maintenance therapy and the other receiving episodic dothiepin therapy if recurrent episodes of depression occurred. Using this model, maintenance therapy with sertraline to prevent recurrent depression was shown to be a cost-effective alternative to episodic tricyclic therapy when compared with other well-established health care interventions, such as the treatment of hypertension or coronary artery bypass surgery.

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