'IT'S PRETTY DRAMATIC': MDD Therapy Aided Cognition in AtWoRK

By Jancin, Bruce | Clinical Psychiatry News, November 2018 | Go to article overview

'IT'S PRETTY DRAMATIC': MDD Therapy Aided Cognition in AtWoRK


Jancin, Bruce, Clinical Psychiatry News


REPORTING FROM THE ECNP CONGRESS

BARCELONA -- Effective pharmacologic treatment of cognitive symptoms in employed patients with major depressive disorder greatly improved their laggardly workplace productivity in the 52-week AtWoRK (Assessment in Work Productivity and the Relationship With Cognitive Symptoms).

"We found that, as patients rated themselves as improved in terms of cognition--'I can think better,' 'I can focus,' 'I'm concentrating better' --there was a strong correlation at 12 weeks and later extended to 1 year with improved work productivity by as much as 75%. It's pretty dramatic," lead investigator Pratap Chokka, MD, said in an interview at the annual congress of the European College of Neuropsychopharmacology.

AtWoRK was a multicenter, open-label, naturalistic intervention study in which 219 gainfully employed Canadian adults with major depressive disorder (MDD) who had presented to primary care physicians or psychiatrists were placed on vortioxetine (Trintellex) flexibly dosed at 10-20 mg/ day and scheduled for routine follow-up visits every 4 weeks for 52 weeks.

This was a patient population with severe depression, severe cognitive dysfunction, severe anxiety, and substantial functional impairment as reflected in their baseline scores on a variety of validated measures (see graphic.) The study was designed to emulate real-world clinical practice.

"We know that patients with depression are very impaired in terms of work productivity. Depressed patients really suffer from absenteeism and presenteeism [reduced productivity at work caused by illness, including depression]. And very few naturalistic studies have been done in working patients with depression," Dr. Chokka said.

"The randomized trials are really important. They show us that a drug is working. But in terms of the real world that I work in, I need to have effectiveness: Does the drug work in patients with comorbid conditions, problems in their home lives, who are maybe drinking alcohol? Those are cases we'd rule out from participation in the RCTs.

"The patients in our study walked into our clinics saying: 'You know what, doctor, my mind isn't working very good. I'm depressed; I can't think; I can't focus; I'm missing work; my boss is on my case; I'm making errors. I need help.' These are the kinds of practicalities we wanted to address," explained Dr. Chokka, a psychiatrist at Grey Nuns Community Hospital in Edmonton, Can.

The primary endpoint in AtWoRK was the correlation between changes in patients' self-reported cognitive symptoms on the 20-item Perceived Deficits Questionnaire--Depression (PDQ-D-20) and changes in work productivity loss measured on the Work Limitations Questionnaire (WLQ) at week 12. …

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