[Work loss and depression. Impact of fluoxetine]

The goal of our study was to explore the impact of various antidepressant drugs on the relative risk of work loss in depressed patients. 1,852 depressed patients (DSM III-R) were observed using a "cross-sectional" design. Patients were included into five groups: patients without antidepressant treatment, patients treated with one of the main antidepressant drugs in France (amineptine amitriptyline, clomipramine and fluoxetine). Primary variables were the depression intensity (Hamilton scores) and job status (work loss). The other parameters (clinical, demographic, economic, therapeutic) were used as potentially predicting variables. Data have been collected through a network of 295 physicians (GP, Psychiatrists). The main socio-demographic characteristics of treated and untreated depressive patients, either working or absent from work, were predominantly female and city dwellers. A significant difference was found between working patients and work loss in terms of professional characteristics, i.e. type of employment (p < 0.001), type of employer (p < 0.05), level of responsibility (p < 0.01) and type of remuneration (p < 0.01). We found a positive correlation between depression severity and the risk of work loss (R2 = 0.86, p < 0.001). This risk was significantly lower with fluoxetine compared to other treatments. Pooling these data with data from clinical trials led to a saving of 2.4 days (vs clomipramine) to 4.7 days (vs amitriptyline) (p < 0.05, respectively) of work loss per patient for a 8-week treatment period.