Clinical Factors Associated With Treatment Resistance in Major Depressive Disorder

Abstract

reatment-resistant depression (TRD) is usually seen as the failure to reach sufficient remission after an Objectives: Very few studies have investigated clinical features associated with treatment-resistant depression (TRD) defined as failure of at least 2 consecutive antidepressant trials. The primary objective of this multicenter study was to identify specific clinical and demographic factors associated with TRD in a large sample of patients with major depressive episodes that failed to reach response or remission after at least 2 consecutive adequate antidepressant treatments.Method: A total of 702 patients with DSM-IV major depressive disorder, recruited from January 2000 to February 2004, were included in the analysis. Among them, 346 patients were considered as nonresistant. The remaining 356 patients were considered as resistant, with a 17-item Hamilton Rating Scale for Depression score remaining greater than or equal to 17 after 2 consecutive adequate antidepressant trials. Cox regression models were used to examine the association between individual clinical variables and TRD.Results: Among the clinical features investigated, 11 variables were found to be associated with TRD. We found anxiety comorbidity (p < .001, odds ratio [OR] = 2.6), comorbid panic disorder (p < .001, OR = 3.2) and social phobia (p = .008, OR = 2.1), personality disorder (p = .049, OR = 1.7), suicidal risk (p = .001, OR = 2.2), severity (p = .001, OR = 1.7), melancholia (p = .018, OR = 1.5), a number of hospitalizations > 1 (p = .003, OR = 1.6), recurrent episodes (p = .009, OR = 1.5), early age at onset (p = .009, OR = 2.0), and nonresponse to the first antidepressant received lifetime (p = .019, OR = 1.6) to be the factors associated with TRD.Conclusions: Our findings provide a set of 11 relevant clinical variables associated with treatment resistance in major depressive disorder that can be explored at the clinical level. The statistical model used in this analysis allowed for a hierarchy of these variables (based on the OR) showing that comorbid anxiety disorder is the most powerful clinical factor associated with TRD.

The lack of association between components of metabolic syndrome and treatment resistance in depression

“…Anxiety comorbidity, comorbid panic disorder and social phobia, personality disorder, suicidal risk, severity of symptoms, melancholic features, more than one hospitalization, recurrent episodes, early age at onset, and non-response to the first antidepressant received lifetime, were all associated with TRD (Souery et al 2007). However, there is no reliable predictor of clinical response to antidepressants in general.…”

Influence of COX-2 and OXTR polymorphisms on treatment outcome in treatment resistant depression

“…Four European centers took part in this project: (i) Department of Psychiatry, Erasme Hospital, Universite Libre de Bruxelles, Brussels, Belgium; (ii) Sint-Truiden, Psychiatric Center, Sint-Truiden, Belgium; (iii) Department of Psychiatry, Chaim Sheba Medical Center, Tel-Hashomer, Israel; (iv) Department of Psychiatry and Psychotherapy, Medical University Vienna, Austria. Detailed description of the whole sample was reported elsewhere [26]. Here we report data on a subsample of patients for which genetic data of COX2 and OXTR were available.…”

“…Patients have been included if they received at least one adequate antidepressant trial during the current or most recent depressive episode. Two definitions of treatment resistance have been considered in the analyses: (1) non response to at least 2 adequate consecutive antidepressant treatments administered during the last episode [26]; (2) non response to at least 2 adequate consecutive antidepressant treatments of different classes (mechanism of action) administered during the last episode [5]. Non resistant patients reported a Hamilton Depression Rating Scale (HDRS) [9] score ≤17 after an adequate antidepressant treatment or at the second trial after a first non response.…”

Spectral model of therapy resistant depression

“…augmentation) -устоявшийся термин в те-ории терапевтически резистентных депрессий, означающий потенцирование (усиление) действия антидепрессанта за счет добавления другого препарата, не относящегося к классу анти-депрессантов. зультативности терапевтических подходов без учета клинических показателей или биологических мар-керов депрессии, которые могли бы влиять на ход терапевтического процесса (необходимость поиска таких показателей обсуждалась в научной литерату-ре [25,26]). Примером такого подхода может слу-жить модель MSM (Maudsley Staging Model) [21].…”