Comorbid Social Phobia and Major Depressive Disorder: the Influence of Remission from Depression on Quality of Life and Functioning

Abstract Social phobia (SP) and major depressive disorder (MDD) are frequently concurrent, which negatively affects quality of life (QOL), functioning, and depressive symptom severity. We hypothesized individuals with comorbid SP and MDD (MDD + SP) would have worse treatment outcomes than those with MDD alone (MDDnoSP), but that both groups would have significant responses to treatment, and those who achieved MDD remission would have the best increases in QOL and functioning. We analyzed data for 2280 adults who received citalopram monotherapy in phase 1 of the NIH-funded Sequenced Treatment Alternatives to Relieve Depression (STAR*D) study. Participants (82 MDD + SP and 2198 MDDnoSP) with complete entry and exit scores across QOL, functioning, and depressive symptom severity were examined. MDD remission status following treatment was determined. Patient-reported QOL and functioning scores were classified as within-normal or severely-impaired. No significant between-group differences were observed across all outcomes at entry or exit. Both groups experienced significant improvements in QOL and functioning (all p values .77). Although non-significant, the MDD + SP group was more likely to achieve within-normal scores and MDD remission post-treatment. Findings were interesting as we initially expected the MDD + SP participants to have worse outcomes, yet those with MDD alone had a more chronic course. Regardless, participants who were able to achieve MDD remission post-treatment had significantly better improvements in QOL and functioning. Accordingly, researchers and clinicians should utilize QOL and functioning measures when examining treatment effectiveness, while also considering the role of remission from major depressive disorder on quality of life.