Experience
sampling method (ESM) to assess antidepressant
efficacy
Quality
of life (QoL) has become an important measure in
depression clinical trials, however its
evaluation is rare and retrospective. Since QoL
varies during the day some investigators have
studied the effects of antidepressants on QoL by
measuring it from moment to moment in daily life
(mQoL) and related aspects of daily
experience.
Primary care patients, diagnosed with major
depression according to DSM-III or DSM-IV, were
randomly assigned to imipramine (n = 32) or
placebo (n = 31) for 6 weeks with a possible
prolongation to 18 weeks. A healthy control
group included 22 individuals. The experience
sampling method (ESM) was used to assess the
effects of antidepressant treatment on mQoL.
There was an association between increases in
frequency and severity of physical complaints
due to treatment (including those not reported
as side effects) and low mQoL. This link was
strong in treatment dropouts. At week 6, in
spite of a greater clinical improvement,
patients treated with imipramine had no higher
increases in mQoL ratings than patients treated
with placebo. However, imipramine patients were
less subject to mQoL fluctuations and spent less
time "doing nothing". Clinical improvement, mQoL
changes and specific early side effects were the
decisional factors for the patients to prolong
treatment. Even though the patients who were in
remission by 18 weeks in comparison to healthy
controls, they still had low levels of daily QoL
measured by ESM, whereas normal values had been
obtained by retrospective measures.
Therefore ESM gives insight into the effects of
antidepressants on day-to-day QoL and should be
added to the arsenal of assessment scales in
clinical trials. J
Clin Psychiat 63: 477-485, 2002