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The impact of fatigue and energy on work functioning and impairment in patients with major depressive disorder treated with desvenlafaxine

Sarfati, Davida,b; Evans, Vanessa C.a,b; Tam, Edwin M.a,b; Woo, Cindya,b; Iverson, Grant L.a,b,c; Yatham, Lakshmi N.a,b; Lam, Raymond W.a,b

International Clinical Psychopharmacology: November 2017 - Volume 32 - Issue 6 - p 343–349
doi: 10.1097/YIC.0000000000000192

Fatigue and low energy are cardinal symptoms of major depressive disorder (MDD) that have an impact on work functioning. Antidepressants with noradrenergic activity have been hypothesized to improve symptoms of fatigue and low energy. We examined the impact of these symptoms on work functioning in patients with MDD treated with the serotonin and noradrenaline reuptake inhibitor, desvenlafaxine. A secondary analysis was carried out from a study of employed adult outpatients (n=35) with MDD and subjective cognitive complaints treated with desvenlafaxine 50–100 mg/day for 8 weeks. Multiple regression analyses modeled improvement in work functioning measures (Lam Employment Absence and Productivity Scale, Health and Work Performance Questionnaire, Sheehan Disability Scale) with measures of fatigue (Patient-Reported Outcomes Measurement Information System Fatigue scale and 20-item Hopkins Symptom Check List Energy scale). Patients showed a significant improvement in Montgomery–Åsberg Depression Rating Scale scores as well as in fatigue and work functioning measures following treatment. Fatigue measures were significantly associated with improvement in some (Lam Employment Absence and Productivity Scale, Sheehan Disability Scale), but not all (Health and Work Performance Questionnaire) work functioning measures, independent of improvement in overall depressive symptoms. The limitations of this study include the small sample size and the lack of a placebo or a comparison group. Fatigue and low energy are important symptoms that are associated with occupational impairment in MDD. Treatments that improve these symptoms are likely to improve work functioning.

aDepartment of Psychiatry, University of British Columbia

bMood Disorders Centre of Excellence, Djavad Mowafaghian Centre for Brain Health, Vancouver, British Columbia, Canada

cDepartment of Physical Medicine and Rehabilitation, Harvard Medical School, and Home Base, a Red Sox Foundation and Massachusetts General Hospital Program, Boston, Massachusetts, USA

Correspondence to Raymond W. Lam, MD, Department of Psychiatry, University of British Columbia, 2255 Wesbrook Mall, Vancouver, BC, Canada V6T 2A1 Tel: +1 604 822 7325; fax: +1 604 822 7922; e-mail:

Received February 17, 2017

Accepted July 5, 2017

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