All-cause mortality in patients with treatment-resistant depression: a cohort study in the US population

Abstract

Background Treatment-resistant depression (TRD) may represent a substantial proportion of major depressive disorder (MDD); however, the risk of mortality in TRD is still incompletely assessed. Methods Data were obtained from Optum Clinformatics™ Extended, a US claims database. Date of the first antidepressant (AD) dispensing was designated as the index date for study entry and 6 months prior to that was considered the baseline period. Patients with MDD aged ≥ 18 years, index date between January 1, 2008 and September 30, 2015, no AD claims during baseline, and continuous enrollment in the database during baseline were included. Patients who started a third AD regimen after two regimens of appropriate duration were included in the TRD cohort. All-cause mortality was compared between patients with TRD and non-TRD MDD using a proportional hazards model and Kaplan–Meier estimate with TRD status being treated as a time-varying covariate. The model was adjusted for study year, age, gender, depression diagnosis, substance use disorder, psychiatric comorbidities, and Charlson comorbidity index. Results Out of 355,942 patients with MDD, 34,176 (9.6%) met the criterion for TRD. TRD was associated with a significantly higher mortality compared with non-TRD MDD (adjusted HR: 1.29; 95% CI 1.22–1.38; p < 0.0001). Survival time was significantly shorter in the TRD cohort compared with the non-TRD MDD cohort (p < 0.0001). Conclusions Patients with TRD had a higher all-cause mortality compared with non-TRD MDD patients.

Clinical characteristics of treatment-resistant depression in adults in Hungary: Real-world evidence from a 7-year-long retrospective data analysis

“…To our knowledge, only two previous studies, one from Sweden and one from the US, have compared the all-cause mortality in patients with TRD versus non-TRD MDD [ 13 , 28 ]. Both studies reported 29–35% higher overall mortality in patients with TRD compared with non-TRD patients [ 13 , 28 ].…”

“…To our knowledge, only two previous studies, one from Sweden and one from the US, have compared the all-cause mortality in patients with TRD versus non-TRD MDD [ 13 , 28 ]. Both studies reported 29–35% higher overall mortality in patients with TRD compared with non-TRD patients [ 13 , 28 ]. Our study demonstrated a 38% increase in mortality in the TRD group compared with the non-TRD group in an age- and gender-adjusted model (HR: 1.38; 95% CI: 1.21–1.57), which is similar to the increases in mortality reported in the two aforementioned studies.…”

“…In addition, an algorithm similar to the one found in Li et al [ 28 ] was used to capture treatment failures in cases of consecutive initiations of different treatments within the same PTD episode. Fig 2 shows the different scenarios in which a treatment can be evaluated and the result (treatment failure or not).…”

How Does Mental Health Impact Women's Heart Health?

“…Serious mental illnesses are not alone in affecting CVD mortality. Depression is also significantly associated with excess mortality [14], with treatmentresistant depression, in particular, resulting in higher allcause [15] and cardiovascular [16] mortality, compared to non-treatment-resistant depression.…”

Use of home health and other healthcare delivery pathways among privately insured patients with and without treatment-resistant depression

“…Failure of a treatment course was defined as a switch of an AD (no more than 180 days after the end of the previous treatment), the addition of an AD, or the initiation of an augmentation therapy. Initiation of a third AD or augmentation medication defined TRD, consistent with recent literature using insurance claims databases to identify patients with TRD 10,[16][17][18][19][20][21][22] .…”