Data on inability to work from an observational study in patients treated with duloxetine for major depressive disorder in clinical practice in Germany were collected. Ability to work was compared between baseline and up to 6 months after initiation of duloxetine. All patients with a working status at baseline other than retired or retired early were included. 2,825 patients were analyzed, 54.8% were able to work at baseline increasing to 83.8% at 6 months. Of those patients unable to work at baseline, 72.7% were able to work after 6 months. A relevant reduction of inability to work was also found for patient subgroups with moderate to severe pain at baseline and those with and without MDD pretreatment. As inability to work is one of the main cost drivers for depressive patients in Germany, the reduction of inability to work could potentially result in considerable cost savings for health insurance companies and society. 1. Introduction Depression is a major reason for disability and has recently become the most important ICD-10 diagnosis for inability to work in Germany as measured by the number of days unable to work [1]. It is also a frequent reason for hospitalization for patients in the active workforce according to the statutory health insurances in Germany [2, 3]. Several studies and reviews have shown that painful physical symptoms (PPSs) are frequent in patients with a depressive disorder [4]. In this context PPS can be defined as depression-related pain not being caused by physical handicaps (e.g., herniated disc). It has been further evaluated that comorbidity of depression and PPS results in a particular high-economic burden due to increased inability to work and hospitalizations compared to depression without comorbid PPS [5–8]. Moreover, the long-term treatment outcomes for depressive patients with comorbid PPS are worse compared to depressive patients without PPS [9, 10]. As inability to work and hospital stays are the 2 major drivers for costs in healthcare system in Germany and most healthcare systems worldwide [11], the successful and early treatment of patients with depression and comorbid PPS may potentially reduce health care costs by a considerable amount. Although treatment with any antidepressant might also reduce associated pain symptoms, the effect on pain has not been assessed for most medications. Of the modern re-uptake inhibitor medications, duloxetine has shown a direct influence on PPS in depressive patients with moderate pain at baseline in a randomized controlled clinical setting [12, 13]. In addition, duloxetine is
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