Finding factors that predict treatment-resistant depression: Results of a cohort study

Abstract

BackgroundTreatment for depressive disorders often requires subsequent interventions. Patients who do not respond to antidepressants have treatment‐resistant depression (TRD). Predicting who will develop TRD may help healthcare providers make more effective treatment decisions. We sought to identify factors that predict TRD in a real‐world setting using claims databases.MethodsA retrospective cohort study was conducted in a US claims database of adult subjects with newly diagnosed and treated depression with no mania, dementia, and psychosis. The index date was the date of antidepressant dispensing. The outcome was TRD, defined as having at least three distinct antidepressants or one antidepressant and one antipsychotic within 1 year after the index date. Predictors were age, gender, medical conditions, medications, and procedures 1 year before the index date.ResultsOf 230,801 included patients, 10.4% developed TRD within 1 year. TRD patients at baseline were younger; 10.87% were between 18 and 19 years old versus 7.64% in the no‐TRD group, risk ratio (RR) = 1.42 (95% confidence interval [CI] 1.37–1.48). TRD patients were more likely to have an anxiety disorder at baseline than non‐TRD patients, RR = 1.38 (95% CI 1.35–1.14). At 3.68, fatigue had the highest RR (95% CI 3.18–4.25). TRD patients had substance use disorders, psychiatric conditions, insomnia, and pain more often at baseline than non‐TRD patients.ConclusionTen percent of subjects newly diagnosed and treated for depression developed TRD within a year. They were younger and suffered more frequently from fatigue, substance use disorders, anxiety, psychiatric conditions, insomnia, and pain than non‐TRD patients.

Investigation of early and lifetime clinical features and comorbidities for the risk of developing treatment-resistant depression in a 13-year nationwide cohort study

“…In addition, our results revealed that anxiety is the strongest predictor of TRD with a high PAF. It is well-known that anxiety and depression/TRD often coexist [ 22 , 23 , 25 ], and that anxiety disorders have been identified as a risk factor of poor treatment response [ 43 ]. A previous study also found that anxiety disorders, particularly panic disorder, are associated with TRD [ 44 ].…”

“…Physical comorbidities, including diabetes [ 15 , 16 ], heart diseases [ 17 ], functional gastrointestinal disorders (FGIDs) [ 18 ], thyroid disease [ 19 ], systemic lupus erythematosus (SLE) [ 20 ], and rheumatoid arthritis [ 21 ], have been implicated in the development and prognosis of common mental disorders, especially mood disorders. In addition, a group of anxiety disorders (including panic disorder, generalized anxiety disorder, social anxiety disorder, and obsessive-compulsive disorder), attention deficit hyperactivity disorder (ADHD), substance use disorders (SUDs), and personality disorders were found to be more prevalent in patients with MDD [ 22 – 25 ], or predictive of worse outcomes or slower remission [ 24 ]. This emergent evidence has indicated that both physical and psychiatric comorbidities might prolong the course of depression and worsen clinical outcomes.…”

Investigation of early and lifetime clinical features and comorbidities for the risk of developing treatment-resistant depression in a 13-year nationwide cohort study 

“…In addition, our results revealed that anxiety is the strongest predictor of TRD with a high PAF. It is well-known that anxiety and depression/TRD often coexist [22,23,25], and that anxiety disorders have been identi ed as a risk factor of poor treatment response [43]. A previous study also found that anxiety disorders, particularly panic disorder, are associated with TRD [44].…”

“…Physical comorbidities, including diabetes [15,16], heart diseases [17], functional gastrointestinal disorders (FGIDs) [18], thyroid disease [19], systemic lupus erythematosus (SLE) [20], and rheumatoid arthritis [21], have been implicated in the development and prognosis of common mental disorders, especially mood disorders. In addition, a group of anxiety disorders (including panic disorder, generalized anxiety disorder, social anxiety disorder, and obsessivecompulsive disorder), attention de cit hyperactivity disorder (ADHD), substance use disorders (SUDs), and personality disorders were found to be more prevalent in patients with MDD [22][23][24][25], or predictive of worse outcomes or slower remission [24]. This emergent evidence has indicated that both physical and psychiatric comorbidities might prolong the course of depression and worsen clinical outcomes.…”

Treatment resistant depression in women with peripartum depression

“…Women with psychosis, bipolar disorder, or dementia before the index date (i.e., the date of the first depression diagnosis during pregnancy or 6 months after a delivery) were excluded to ensure that any antipsychotic received was for the treatment of depression and not for the treatment of psychosis. Women with bipolar disorder were excluded because when TRD is studied and defined this type of depression is often excluded [19, 20].…”