Treated vs. Untreated Depressed Patients, What Do We Really Know?

How do treated and untreated depressed patients fare after total joint arthroplasty (TJA)? This is what a team of multicenter researchers set out to determine.

Their work, “Depression Treatment Is Not Associated With Improved Patient-Reported Outcomes Following Total Joint Arthroplasty,” appears in the August 9, 2019 edition of The Journal of Arthroplasty.

Co-author Mohamad Halawi, M.D., assistant professor of orthopaedic surgery at the University of Connecticut explained the genesis of this study to OTW, “It is estimated that one out of four patients undergoing hip and knee replacement has history of clinical diagnosis of depression.”

“While the negative impact of depression on postoperative outcomes is well established, up until today, it was unclear whether pharmacological treatment could mitigate this negative effect. Most studies on this topic recommended patient counseling and ‘optimization’ yet stopped short of defining optimization.”

“We only assessed pharmacological treatment, which was variable per patient, but mostly involved the use of serotonin reuptake inhibitors. Alternative modalities, such as behavioral therapy, were not assessed.”

To find answers, Dr. Halawi and his team enrolled patients who had received primary, elective, unilateral total joint arthroplasty and then divided the subjects into three groups based on a self-reported history of depression and treatment at the time of surgery.

The research team found that 25% of the patients in their study had experienced depression. Compared to patients with depression, untreated patients had a lower baseline SF-12 MSC (Short Form Health Survey), a measure of health-related quality of life and were more likely to have Medicaid insurance.

The authors wrote, “After controlling for potential confounding factors, there were no differences in either the absolute scores or net changes in any of the assessed outcomes at 12 months postoperatively among depressed patients regardless of the treatment…”

Dr. Halawi explained the results of the study to OTW, “There is a clear link between depression and a lower perception of improvement after joint replacement surgery even with in those patients who received pharmacological treatment. The picture is not all pessimistic, however. Drawing on the current study and our previous work, patients with depression but good mental health—reflecting compensated biopsychosocial functioning—do just as well as patients without depression. Resilience and support are perhaps key ingredients to achieving good mental health.”

“Future work should explore the role of biopsychosocial approach, as opposed to pharmacological treatment alone, in patients with depression undergoing total joint replacement.”