Clinical Characteristics and Management of Treatment-Resistant Depression

Abstract

To the Editor: Approximately one-third of patients with major depressive disorder (MDD) are treatment resistant. 1,2 Despite high prevalence, the clinical characteristics and management of treatment-resistant depression (TRD) are not well described. We present a comprehensive clinical description of a case series of 79 well-characterized patients with TRD referred to a university-based TRD specialty clinic.Method. Of 104 patients referred to our TRD clinic from 2009 to 2014, 79 met clinic inclusion criteria: DSM-IV-TR-defined MDD with resistance to ≥ 3 antidepressant trials of adequate dose and duration and no diagnoses of bipolar I or II disorder, personality disorder, psychotic disorder, or alcohol or drug abuse/dependence. Medical records for psychiatric treatments within at least 5 years were obtained. Psychiatric history, including symptom, clinical, family, and treatment information, was obtained at the initial visit. Patients completed the Montgomery-Asberg Depression Rating Scale (MADRS). 3 Institutional review board approval and patient consent were obtained for research use of data.Results. Of the 79 patients, 67% (n = 53) were women; the mean age was 49.3 years (SD = 14.2). One-third (n = 26) were receiving disability support. The mean age at MDD onset was 24.3 years (SD = 13.8), with 50% of patients reporting MDD onset after age 18. The mean number of lifetime MDD episodes was 2.6 (SD = 1.7), with 70% (n = 55) of patients reporting ≥ 2 episodes; 30% (n = 24) reported 1 sustained MDD episode. The mean number of lifetime MDD years was 18.6 (SD = 10.0), with 51% (n = 40) of patients reporting ≥ 18 years. Most patients, 63% (n = 50), reported at least 1 psychiatric hospitalization; 21% (n = 17) reported ≥ 4 hospitalizations (maximum = 20). Of those hospitalized at least once, the mean number of hospitalizations was 3.8 (SD = 4.3); 43% (n = 34) of all patients reported ≥ 2 hospitalizations. At least 1

Correlation of clinical features with hs‑CRP in TRD patients

“…Results of this study manifested that the total course of disease of the TRD patients was longer than that of the non-TRD patients, and the onset age was lower than that of the non-TRD patients before treatment. Conway et al (5) found that the course of disease of TRD patients is longer, suggesting that the disease of such patients is more likely to be chronic. According to the study of Juruena et al (6), it was also confirmed that the longer the single course of TRD in patients is, the worse the recovery of social function will be.…”

Treatment-Resistant Major Depression: Rationale for NMDA Receptors as Targets and Nitrous Oxide as Therapy

“…Observations on the first 79 patients evaluated in the TRMD Clinic have been reported elsewhere ( 25 ) but are instructive and relevant to the pilot clinical study of nitrous oxide described below. Patients seen in the TRMD Clinic range in age from 19 to 85 years and have an early onset of MDD, averaging 24.3 years of age at onset.…”

“…In an effort to deal with the common problem of TRMD and its complexity, Conway and colleagues ( 25 ) established the Washington University TRMD Clinic. The goal of this clinic is to provide a systematic and comprehensive evaluation and consultation program for persons with well defined TRMD, focusing primarily on patients with pure unipolar MDD.…”

“…Patients enrolled in this study averaged 48 years of age, were 60% women, and had experienced a mean lifetime history of 19 years of MDD and eight documented antidepressant failures; four had failed ECT and three had failed VNS; thus, the patients studied with nitrous oxide mirrored the patients in the TRMD Clinic and involved individuals with a high degree of treatment refractoriness ( 25 ). Interestingly, 10 patients had a history of migraine headaches and 4 had a history of corrected hypo­thyroidism.…”

Curcumin-based pyrazoline analogues as selective inhibitors of human monoamine oxidase A

“…The use of monoamine oxidase inhibitors (MAOIs) as an effective treatment for depression dates back to the 1950s. [1][2][3][4] The subsequent decades marked the discovery of more potent inhibitors that provided enhanced selectivity between isozymes MAO-A and MAO-B and had reversible binding with MAO. 5 However, safety concerns have markedly decreased their use in recent years, necessitating the search for alternative MAOIs.…”