The impact of psychotherapy, pharmacotherapy, and their combination on quality of life in depression.

BACKGROUND: Quality of life (QOL) is known to be negatively affected during the course of major depressive disorder. Various studies have documented the benefits of pharmacotherapy or psychotherapy alone on QOL in depression, with few studies examining combined treatment. This review will examine the evidence for the impact of each modality, as well as their combination, on QOL in depression. METHODS: Using the key terms depression, depress*, major depress*, quality of life, antidepressant*, and psychotherapy, MEDLINE and PsycINFO searches were conducted to identify treatment-outcome studies that used known QOL measurements over the past twenty-six years (1984 to 2010). RESULTS: Significant improvements in depressive symptomatology and QOL measurements were found with pharmacotherapy, psychotherapy, and their combination, with some studies showing greater improvement following combined treatment than with either intervention alone. CONCLUSIONS: Substantial evidence suggests that psychotherapy, pharmacotherapy, and their combination have favorable effects on QOL in depression. While some studies have shown that combined therapy is superior than either of the two forms alone in improving QOL, additional research is needed to elucidate this effect. QOL measurement is an important dimension of treatment-outcome assessment in patients with depression.

Quality of life: the ultimate outcome measure of interventions in major depressive disorder.

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.