Hostname: page-component-745bb68f8f-mzp66 Total loading time: 0 Render date: 2025-02-06T12:17:13.607Z Has data issue: false hasContentIssue false
  • English
  • Français

Anhedonia predicts poor psychosocial functioning: Results from a large cohort of patients treated for major depressive disorder by general practitioners

Published online by Cambridge University Press:  23 March 2020

F. Vinckier ,
D. Gourion  and
S. Mouchabac
F. Vinckier*
Affiliation:
Service de psychiatrie, faculté de médecine, centre hospitalier Sainte-Anne, université Paris Descartes, Sorbonne Paris Cité, 75014Paris, France Motivation, brain, and behavior lab, institut du cerveau et de la moelle épinière, groupe hospitalier Pitié-Salpêtrière, 75013Paris, France
D. Gourion
Affiliation:
17, rue des Marronniers, 75016Paris, France
S. Mouchabac
Affiliation:
Service de psychiatrie, psychiatry and medical psychology department, hospital Saint-Antoine, université Paris 6 184, rue du Faubourg-Saint-Antoine, 75012Paris, France
*
* Corresponding author. Service hospitalo-universitaire, hôpital Sainte-Anne, 7, rue Cabanis, 75014 Paris, France. E-mail address:[email protected] (F. Vinckier).
Get access

Abstract

Background:

Anhedonia is a core symptom of major depression and a key prognostic factor that is often poorly explored in clinical trials of major depressive disorder (MDD). Beyond symptomatic remission, psychosocial functioning also reveals difficulty in achieving remission in patients with MDD. The main objective of this study was to explore the interrelationships between social functioning and anhedonia on a longitudinal basis.

Methods:

In total, 1570 outpatients treated for MDD with agomelatine were included. Severity of depression and levels of anhedonia and of psychosocial functioning were assessed at inclusion and at 10–14 weeks, with specific standardized scales (MADRS, QFS, SHAPS, CGI). Multivariate regression and mediation analyses were performed.

Results:

Using multivariate regression, we showed that improvement of anhedonia was the strongest predictor of improvement in psychosocial functioning (odds ratio = 7.3 [4.3–12.1] P < 0.0001). In addition, mediation tests confirmed that the association between improvement of depressive symptoms and improvement of social functioning was significantly underpinned by the improvement of anhedonia over time. Finally, we explored the determinants of the dissociation of the response, i.e., the persistence of psychosocial dysfunctioning despite a symptomatic response to antidepressant treatment, which remains a widespread situation in clinical practice. We showed that this dissociation was strongly predicted by persistence of anhedonia.

Conclusion:

Our results suggest that anhedonia is one of the strongest predictors of psychosocial functioning, along with symptomatic remission, and should be carefully assessed by health professionals, in order to optimize pharmacological as well as non-pharmacological management of depression.

Keywords

Unipolar depressionAnhedoniaPsychosocial functioningAntidepressantAgomelatineQuality of life
Type
Original article
Information
European Psychiatry , Volume 44 , July 2017 , pp. 1 - 8
Copyright
Copyright © European Psychiatric Association 2017

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Der-Avakian, AMarkou, AThe neurobiology of anhedonia and other reward-related deficits. Trends Neurosci 2012; 35(1): 68–77.10.1016/j.tins.2011.11.005CrossRefGoogle ScholarPubMed
Rizvi, SJPizzagalli, DASproule, BAKennedy, SHAssessing anhedonia in depression: potentials and pitfalls. Neurosc Biobehav Rev 2016; 65: 21–35.10.1016/j.neubiorev.2016.03.004CrossRefGoogle ScholarPubMed
Spijker, JBijl, RVde Graaf, RNolen, WADeterminants of poor 1-year outcome of DSM-III-R major depression in the general population: results of the Netherlands Mental Health Survey and Incidence Study (NEMESIS). Acta Psychiatr Scand 2001; 103(2): 122–130.10.1034/j.1600-0447.2001.103002122.xCrossRefGoogle Scholar
Uher, RPerlis, RHenigsberg, NZobel, ARietschel, MMors, O, et al.Depression symptom dimensions as predictors of antidepressant treatment outcome: replicable evidence for interest-activity symptoms. Psychol Med 2012; 42(05): 967–980.10.1017/S0033291711001905CrossRefGoogle ScholarPubMed
McMakin, DLOlino, TMPorta, GDietz, LJEmslie, GClarke, G, et al.Anhedonia predicts poorer recovery among youth with selective serotonin reuptake inhibitor treatment-resistant depression. J Am Acad Child Adolesc Psychiatry 2012; 51(4): 404–411.10.1016/j.jaac.2012.01.011CrossRefGoogle ScholarPubMed
Lam, RWFilteau, MJMilev, RClinical effectiveness: the importance of psychosocial functioning outcomes. J Affect Disord 2011;132(Suppl. 1):S9–S13.10.1016/j.jad.2011.03.046CrossRefGoogle ScholarPubMed
Kennedy, NFoy, KSherazi, RMcDonough, MMcKeon, PLong-term social functioning after depression treated by psychiatrists: a review. Bipolar Disord 2007;9(1-2):25–37.10.1111/j.1399-5618.2007.00326.xCrossRefGoogle ScholarPubMed
Bosc, MAssessment of social functioning in depression. Compr Psychiatry 2000; 41(1): 63–69.10.1016/S0010-440X(00)90133-0CrossRefGoogle ScholarPubMed
Hirschfeld, RMontgomery, SAKeller, MBKasper, SSchatzberg, AFMöller, H.-J., et al.Social functioning in depression: a review. J Clin Psychiatry 2000 10.4088/JCP.v61n0405CrossRefGoogle ScholarPubMed
Miller, IWKeitner, GISchatzberg, AFKlein, DNThase, MERush, AJ, et al.The treatment of chronic depression, part 3: psychosocial functioning before and after treatment with sertraline or imipramine. J Clin Psychiatry 1998CrossRefGoogle ScholarPubMed
Solomon, DALeon, ACEndicott, JMueller, TICoryell, WShea, MT, et al.Psychosocial impairment and recurrence of major depression. Compr Psychiatry 2004; 45(6): 423–430.10.1016/j.comppsych.2004.07.002CrossRefGoogle ScholarPubMed
Weissman, MMSocial functioning and the treatment of depression. J Clin Psychiatry 2000Google ScholarPubMed
Zimmerman, MMcGlinchey, JBPosternak, MAFriedman, MBoerescu, DAttiullah, NDiscordance between self-reported symptom severity and psychosocial functioning ratings in depressed outpatients: implications for how remission from depression should be defined. Psychiatry Res 2006; 141(2): 185–191.10.1016/j.psychres.2005.05.016CrossRefGoogle ScholarPubMed
Zimmerman, MMcGlinchey, JBPosternak, MAFriedman, MBoerescu, DAttiullah, NRemission in depressed outpatients: more than just symptom resolution?. J Psychiatr Res 2008; 42(10): 797–801.10.1016/j.jpsychires.2007.09.004CrossRefGoogle ScholarPubMed
Buckner, JDJoiner, TE Jr.Pettit, JWLewinsohn, PMSchmidt, NBImplications of the DSM's emphasis on sadness and anhedonia in major depressive disorder. Psychiatry Res 2008;159(1–2):25–30.10.1016/j.psychres.2007.05.010CrossRefGoogle ScholarPubMed
Snaith, RPHamilton, MMorley, SHumayan, AHargreaves, DTrigwell, PA scale for the assessment of hedonic tone the Snaith-Hamilton Pleasure Scale. BJP 1995; 167(1): 99–103.10.1192/bjp.167.1.99CrossRefGoogle ScholarPubMed
Loas, GDubal, SPerot, PTirel, FNowaczkowski, PPierson, AÉtude de validation de la version française de l’échelle de plaisir de Snaith et Hamilton (Snaith-Hamilton Pleasure Scale, SHAPS, Snaith et al., 1995): détermination des paramètres métrologiques chez 208 sujets sains et chez 103 malades hospitalisés présentant une dépression ou une schizophrénie. Encephale 1997; 23(6): 454–458.Google Scholar
Zanello, AWeber Rouget, BGex-Fabry, MMaercker, AGuimon, JValidation du Questionnaire de fonctionnement social (QFS), un autoquestionnaire mesurant la fréquence et la satisfaction des comportements sociaux d’une population adulte psychiatrique. Encephale 2006; 32(1): 45–59.10.1016/S0013-7006(06)76136-XCrossRefGoogle Scholar
Nicastro, RZanello, AMerlo, MMcQuillan, ACaractéristiques psychométriques du questionnaire de fonctionnement social chez des patients borderline. Encephale 2009; 35(5): 436–442.10.1016/j.encep.2008.06.003CrossRefGoogle Scholar
Martinotti, GSepede, GGambi, FDi Iorio, GDe Berardis, DDi Nicola, M, et al.Agomelatine versus venlafaxine XR in the treatment of anhedonia in major depressive disorder: a pilot study. J Clin Psychopharmacol 2012; 32(4): 487–491.CrossRefGoogle Scholar
Di Giannantonio, MMartinotti, GAnhedonia and major depression: the role of agomelatine. Eur Neuropsychopharmacol 2012;22(Suppl. 3):S505–S510.CrossRefGoogle ScholarPubMed
Di Giannantonio, MDi Iorio, GGuglielmo, RDe Berardis, DConti, CAcciavatti, T, et al.Major depressive disorder, anhedonia and agomelatine: an open-label study. J Biol Regul Homeost Agents 2010; 25(1): 109–114.Google Scholar
Montgomery, SAAsberg, MA new depression scale designed to be sensitive to change. BJP 1979; 134(4): 382–389.10.1192/bjp.134.4.382CrossRefGoogle ScholarPubMed
Busner, JTargum, SDThe clinical global impressions scale: applying a research tool in clinical practice. Psychiatry (Edgmont) 2007; 4(7): 28Google Scholar
Nakonezny, PACarmody, TJMorris, DWKurian, BTTrivedi, MHPsychometric evaluation of the Snaith-Hamilton pleasure scale in adult outpatients with major depressive disorder. Int Clin Psychopharmacol 2010; 25(6): 328–333.10.1097/YIC.0b013e32833eb5eeCrossRefGoogle ScholarPubMed
Franken, IHRassin, EMuris, PThe assessment of anhedonia in clinical and non-clinical populations: further validation of the Snaith-Hamilton Pleasure Scale (SHAPS). J Affect Disord 2007;99(1–3):83–89.CrossRefGoogle Scholar
Keller, MBPast, present, and future directions for defining optimal treatment outcome in depression: remission and beyond. JAMA 2003; 289(23): 3152–3160.10.1001/jama.289.23.3152CrossRefGoogle ScholarPubMed
Trivedi, MHCorey-Lisle, PKGuo, ZLennox, RDPikalov, AKim, ERemission, response without remission, and nonresponse in major depressive disorder: impact on functioning. Int Clin Psychopharmacol 2009; 24(3): 133–138.10.1097/YIC.0b013e3283277614CrossRefGoogle ScholarPubMed
Romera, IPerez, VMenchon, JMDelgado-Cohen, HPolavieja, PGilaberte, ISocial and occupational functioning impairment in patients in partial versus complete remission of a major depressive disorder episode. A six-month prospective epidemiological study. Eur Psychiatry 2010; 25(1): 58–65.CrossRefGoogle Scholar
Romera, IPerez, VMenchon, JMPolavieja, PGilaberte, IOptimal cutoff point of the Hamilton Rating Scale for Depression according to normal levels of social and occupational functioning. Psychiatry Res 2011; 186(1): 133–137.CrossRefGoogle ScholarPubMed
Kennedy, NPaykel, EResidual symptoms at remission from depression: impact on long-term outcome. J Affect Disord 2004; 80(2): 135–144.CrossRefGoogle ScholarPubMed
Judd, LLAkiskal, HSZeller, PJPaulus, MLeon, ACMaser, JD, et al.Psychosocial disability during the long-term course of unipolar major depressive disorder. Arch Gen Psychiatry 2000; 57(4): 375–380.CrossRefGoogle ScholarPubMed
Zimmerman, MPosternak, MAChelminski, IHeterogeneity among depressed outpatients considered to be in remission. Compr Psychiatry 2007; 48(2): 113–117.CrossRefGoogle ScholarPubMed
Zimmerman, MMartinez, JAttiullah, NFriedman, MToba, CBoerescu, DA, et al.Further evidence that the cutoff to define remission on the 17-item Hamilton Depression Rating Scale should be lowered. Depress Anxiety 2012; 29(2): 159–165.10.1002/da.20870CrossRefGoogle ScholarPubMed
Zimmerman, MPosternak, MAChelminski, IIs the cutoff to define remission on the Hamilton Rating Scale for Depression too high?. J Nerv Ment Dis 2005; 193(3): 170–175.CrossRefGoogle ScholarPubMed
Romera, IPérez, VCaballero, LRoca, MPolavieja, PGilaberte, IResidual symptoms and functioning in depression, does the type of residual symptom matter? A post-hoc analysis. BMC Psychiatry 2013; 13(1): 51CrossRefGoogle Scholar
Romera, IPerez, VQuail, DBerggren, LLenox-Smith, AGilaberte, IIndividual residual symptoms and functional impairment in patients with depression. Psychiatry Res 2014;220(1–2):258–262.CrossRefGoogle Scholar
Mintz, JMintz, LIArruda, MJHwang, SSTreatments of depression and the functional capacity to work. Arch Gen Psychiatry 1992; 49(10): 761–768.CrossRefGoogle ScholarPubMed
Finkelstein, SNBerndt, ERGreenberg, PEParsley, RARussell, JMKeller, MBImprovement in subjective work performance after treatment of chronic depression: some preliminary results. Chronic Depression Study Group. Psychopharmacol Bull 1995; 32(1): 33–40.Google Scholar
Hirschfeld, RMDunner, DLKeitner, GKlein, DNKoran, LMKornstein, SG, et al.Does psychosocial functioning improve independent of depressive symptoms? A comparison of nefazodone, psychotherapy, and their combination. Biol Psychiatry 2002; 51(2): 123–133.10.1016/S0006-3223(01)01291-4CrossRefGoogle ScholarPubMed
Paykel, ESWeissman, MMSocial adjustment and depression: a longitudinal study. Arch Gen Psychiatry 1973; 28(5): 659–663.CrossRefGoogle Scholar
Warden, DRush, AJTrivedi, MHFava, MWisniewski, SRThe STAR*D Project results: a comprehensive review of findings. Curr Psychiatry Rep 2007; 9(6): 449–459.CrossRefGoogle Scholar
Submit a response

Comments

No Comments have been published for this article.