Patient Perspectives of Meaningful Change in Major Depressive Disorder

This work was sponsored by Sage Therapeutics, Inc. and Biogen, Inc. Introduction: Limited research exists on the level of change in depressive symptoms that is meaningful to patients with major depressive disorder (MDD). The purpose of the current study was to explore what these patients value in their recovery, including changes in symptoms and impacts they consider to be meaningful. Methods: Qualitative semi-structured interviews were conducted with 19 adults with MDD and 5 psychiatrists with experience treating patients with MDD in the US. Results: Findings from patient interviews highlighted the episodic and heterogeneous nature of MDD, as well as the importance of functioning to patients. For all but two PHQ-9 items, a 1-point improvement was most frequently endorsed by patients (42%-58%) as the minimal level of meaningful improvement. Over half of patients indicated a 1-point improvement on the PGI-S (n=11/18; 61%) and ‘minimally improved’ on the PGI-C (n=11/19; 58%) reflects a minimum meaningful improvement in MDD symptoms. In addition to functional and symptom improvement, patients described what a successful treatment for MDD looks like including minimal side effects (n=12/19; 63%), treatment durability (n=9/19; 47%), and rapid symptom improvement (n=6/19; 32%). Results from supportive psychiatrist interviews were consistent with patient findings, and clinicians generally believed the definition of meaningful change in MDD is dependent on each individual patient. Conclusions: Interviewed patients with MDD desired improvements in daily functioning and indicated that any improvement in depressive symptoms, as measured by the PHQ-9, PGI-S and PGI-C, can be meaningful. These patients expressed desires for durable and rapid-acting treatments for MDD with minimal side effects.