Patient life engagement: helping patients with depression to take their lives back

By Pratap Chokka, Jeffrey Habert, Roger S McIntyre

Depression robs people of their ability to engage in the things that matter most in life. This loss of “patient life engagement” is one of the most debilitating, discouraging, and impairing aspects of depression. It not only reduces overall quality of life, but also results in a vicious cycle of functional impairment. Consequently, as well as improving depressive symptoms, patients with depression value treatment outcomes such as regaining optimism and self-confidence, feeling like their usual selves, and returning to their normal levels of functioning.

Dr Chokka observes that depression trials have historically focused on improving depressive symptoms, with few trials exploring well-being and engagement. Recently, the Canadian “ENGAGE” study showed that treatment with adjunctive brexpiprazole in patients with depression and inadequate antidepressant response not only improved depressive symptoms and functioning, but also allowed patients to re-engage in day-to-day life. Patients described feeling more joy and happiness, making meaningful connections with their friends and partners, their work being more productive, and, most importantly, re-engaging in activities and hobbies. Thus, the ENGAGE study highlights the importance of focusing on well-being, quality of life, and engagement in future trials of depression.

Dr Habert notes that primary care providers are usually the first point of contact for patients with depression. By incorporating patient life engagement into treatment strategies, primary care physicians can empower patients to regain a sense of purpose and fulfilment in their lives. Encouraging participation in meaningful activities, tailored to each patient’s interests and abilities, enhances patients’ overall quality of life and mental health outcomes. By advocating for improvement in patient life engagement, primary care physicians thereby reinforce the commitment to positive mental health outcomes for patients with depression.

Dr McIntyre believes that the future of psychiatry is to identify treatments that can improve patient life engagement – it is no longer enough to simply improve symptoms of depression and anxiety. It is Dr McIntyre’s belief that the results of the ENGAGE study provide hope for people living with mental disorders – that patients can think not only about symptoms improving, but also about taking their lives back.

Editorial support for this blog was provided by Liz Kelly, BSc, of Cambridge (a division of Prime, Knutsford, UK), funded by Otsuka Canada Pharmaceuticals Inc. (Saint-Laurent, Quebec, Canada) and Lundbeck Canada Inc. (Saint-Laurent, Quebec, Canada).

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Article Details
Adjunctive Brexpiprazole for Patient Life Engagement in Major Depressive Disorder: A Canadian, Phase 4, Open-Label, Interventional Study: Brexpiprazole d'appoint pour l'engagement dans la vie des patients souffrant de trouble dépressif majeur: une étude interventionnelle canadienne ouverte de phase 4
Authors: François Therrien, Caroline Ward, Pratap Chokka, Jeffrey Habert, Zahinoor Ismail, Roger S. McIntyre, Erin M. MacKenzie
First published March 1, 2024 Research article
DOI: 10.1177/07067437241233965
The Canadian Journal of Psychiatry

About the Authors

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Dr Jeffrey Habert is a Family Physician, and an Assistant Professor in the Department of Family and Community Medicine at the University of Toronto (Canada). Dr Habert’s clinical interests include diabetes, obesity, depression, ADHD, insomnia, thrombosis/stroke and osteoporosis. Dr Habert holds an interest in the use of clinical practice guidelines, and has participated on committees to establish guidelines in the areas of depression, stroke, ASA in primary care, and thrombosis. He is a co-author on the recently released CANMAT Depression Guidelines. He is the previous co-chair of Thrombosis Canada Clinical Guides. Dr Habert is a national speaker in the multiple areas, and actively participates on Scientific Committees involved in the creation of educational programs.

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Dr Pratap Chokka is a practicing Psychiatrist, and a Professor in the Department of Psychiatry at the University of Alberta (Canada). Ten years ago, Dr Chokka formed the Chokka Center for Integrative Health in Edmonton, Canada, with a central purpose to help people achieve better functioning and quality of life. Dr Chokka aims to facilitate an integrated, multi-faceted approach for the treatment of the whole person. Dr Chokka encourages his patients learn, grow, adapt and face struggles head on, with an aim for patients to achieve a life of purpose, satisfaction and meaning. Dr Chokka has also contributed to research via involvement in numerous clinical trials of treatments for various mental health disorders.

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Dr Roger McIntyre is a Professor of Psychiatry and Pharmacology at the University of Toronto, and Executive Director of the Brain and Cognition Discovery Foundation in Toronto (Canada). Dr McIntyre is involved in multiple research endeavours that aim to characterize the phenomenology, neurobiology, and novel therapeutics of mood disorders. Dr McIntyre is especially interested in identifying innovative, rapid-acting psychotropic treatments for mood disorders. Dr McIntyre’s research has also extended into public health, and implementation of research at the population-based level. Dr McIntyre has published widely, having authored/co-authored more than 1,000 articles/manuscripts, and edited and/or co-edited several textbooks on mood disorders. Dr McIntyre is also involved in medical education, and has contributed extensively to clinical practice guidelines.