Effect of continuation treatment on health-related quality of life in remitted psychotic depression

BACKGROUND: Continuation treatment with sertraline plus olanzapine is associated with lower risk of relapse of remitted psychotic depression than sertraline plus placebo. We examined the effect of continuation pharmacotherapy on health-related quality of life (HRQOL) in remitted psychotic depression. METHODS: One hundred and twenty-six men and women, aged 18 to 85 years, who had achieved sustained remission of psychotic depression with open-label treatment with sertraline plus olanzapine were randomized to continue sertraline plus either olanzapine or placebo. HRQOL was measured with the 36-item Short Form Health Survey (SF-36) at randomization baseline and study termination. The primary outcome was change in each of the eight SF-36 domains. Linear regression examined the relationship between randomized treatment and change in SF-36 domain scores. RESULTS: Sertraline plus olanzapine was associated with better outcomes in the Role Emotional (RE) and Mental Health (MH) domains than sertraline plus placebo. Relapse was associated with marked decline in both RE and MH scores. RE and MH scores at study termination were more than two standard deviations below the population mean in approximately one quarter of participants in the sertraline plus placebo group. CONCLUSIONS: In individuals with remitted psychotic depression, continuation treatment with sertraline plus olanzapine was associated with better outcomes in HRQOL domains directly relevant to mental health than treatment with sertraline plus placebo. These findings suggest that the benefit of sertraline plus olanzapine in preventing relapse of psychotic depression is associated with benefit in HRQOL.