A research paper published in the July online edition of The American Journal of Psychiatry shows that patients who experienced significant clinical remission in initial treatment were more likely to experience significant productivity gains than those who were treatment resistant; in contrast, patients who experienced remission in the second phase of treatment continued to have work impairment; and patients who had some degree of treatment resistance were more likely to experience persistent impairment in work productivity, suggesting that such patients require an additional, novel treatment approach. The investigators sought to determine baseline clinical and sociodemographic characteristics related to work productivity in outpatients with depression and to assess the impact of treatment on their work productivity. A total of 1928 depressed patients aged 18-75 years were recruited for the study, and participants were required to complete the Productivity and Activity Disorders Scale beforehand and take citalopram 20-40 mg daily in a sequential treatment-relieving depression study. Patients who did not remit after an initial adequate antidepressant trial (phase 1) were allowed to switch to sertraline, bupropion extended-release, venlafaxine extended-release, bupropion or buspirone extended-release plus augmentation (phase 2). The study assessed participants’ clinical and sociodemographic characteristics related to baseline work productivity, treatment regression, and changes in work productivity over time. Participants’ education, baseline depression level, depressive, atypical and recurrent depression subtypes were all independently associated with low work productivity. In the first treatment phase, productivity improved in part through depressive symptom improvement, although, these findings were not validated by the second phase of transfer; there was no significant association between cure and remission of work impairment; the findings were largely confirmed when multiple attributions were included for missing data, and severe productivity impairment was found to be associated with higher levels of anxious depression in this additional assessment .