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Quality of Life: The Ultimate Outcome Measure of Interventions in Major Depressive Disorder

IsHak, Waguih William MD, FAPA1; Greenberg, Jared Matt MD1; Balayan, Konstantin MD1; Kapitanski, Nina MD1; Jeffrey, Jessica MD, MPH, MBA1; Fathy, Hassan MD1; Fakhry, Hala MD1; Rapaport, Mark Hyman MD1

doi: 10.3109/10673229.2011.614099

Background: Quality-of-life (QOL) assessment and improvement have recently been recognized as important components of health care, in general, and mental health care, in particular. Patients with major depressive disorder (MDD) have a significantly diminished QOL.

Methods: Using a Medline search of relevant keywords for the past 26 years, this article reviews the empirical literature to provide information regarding QOL measurement, impairment, impact of comorbidity, and treatment effects in MDD.

Results: Studies showed that QOL is greatly affected by depression. Severity of depression is also a major contributor to further reduction in QOL when depression is comorbid with other psychiatric and medical disorders. Treatment for MDD has been shown to improve QOL in the acute treatment phase, but QOL remains low compared to healthy controls even when symptoms are in remission following treatment.

Conclusions: Patients with MDD suffer from poor QOL even after reduction of symptom severity. Clinicians should therefore include QOL assessment as an important part of treating depression. More research is needed to examine the factors contributing to poor QOL in MDD and to develop interventions to ameliorate it. Additionally, future treatment studies of MDD with or without comorbid disorders should track QOL as the ultimate outcome measure of treatment success.

1 From the University of California, Los Angeles Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine (Drs. IsHak, Greenberg, Jeffrey, and Rapaport); Department of Psychiatry and Behavioral Neurosciences, Cedars-Sinai Medical Center, Los Angeles, CA (Drs. IsHak, Balayan, and Rapaport); Department of Psychiatry, Stanford University School of Medicine (Dr. Kapitanski); Department of Psychiatry, State University of New York, Brooklyn School of Medicine (Dr. Fathy); Department of Psychiatry, Faculty of Medicine, Cairo University, Cairo, Egypt (Dr. Fakhry).

Supported by a Young Investigator Award (Dr. IsHak) from the National Alliance for Research on Schizophrenia and Depression.

Correspondence: Waguih William IsHak, MD, FAPA, Cedars-Sinai Medical Center, Department of Psychiatry and Behavioral Neurosciences, 8730 Alden Dr., Suite W-101, Los Angeles, CA 90048. Email: E-mail:

Original manuscript received July 2, 2010; revised manuscript received December 10, 2010, accepted for publication March 27, 2011.

Declaration of interest: Dr. IsHak has received research support from the National Alliance for Research on Schizophrenia and Depression (Quality of Life in Major Depression) and from Pfizer (Geodon in Major Depression). Dr. Rapaport has also received research support from NARSAD, served as a consultant to Affectis Pharmaceutics, Astellas Pharma US, Brain Cells, Dainippon Sumitomo Pharma, Johnson & Johnson, Methylation Sciences, PAX Pharmaceuticals, Quintiles/AstraZeneca, Takeda Pharmaceutical, and Wyeth.

© 2011 President and Fellows of Harvard College
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