The humanistic and economic burden of treatment-resistant depression in Europe: a cross-sectional study

Abstract

Background A patient is considered to suffer from treatment resistant depression (TRD) when consecutive treatment with two products of different pharmacological classes, used for a sufficient length of time at an adequate dose, fail to induce a clinically meaningful effect (inadequate response). The primary aim of the current study was to examine the humanistic and economic burden of TRD in five European countries, France, Germany, Italy, Spain and the United Kingdom, by comparing with non-treatment resistant depression (nTRD) and general population respondents. Methods The sample for this retrospective observational study was taken from the 2017 National Health and Wellness Survey conducted in five European countries. Demographic and patient characteristics were examined for TRD patients compared to respondents with nTRD and to the general population using chi-square tests or one-way analysis of variance for categorical or continuous variables, respectively. Generalized linear models were performed to examine group differences after adjusting these estimates for confounders. Results A total 52,060 survey respondents were examined, of which 2686 and 622 were considered to have non-treatment resistant and treatment-resistant depression, respectively. Relative to the general population, nTRD and TRD respondents reported significant decrements in health-related quality of life, including lower adjusted mental (− 12.1 vs. -18.1) and physical (− 2.5 vs. -5.4) component scores of the SF-12v2 and increased adjusted relative risk for work (2.2 vs. 2.7) and activity (1.9 vs. 2.5) impairment (all p < 0.001). Additionally, healthcare resource utilization was significantly higher for TRD patients more so than nTRD, compared to the general population, especially for healthcare professional visits (odds ratio nTRD = 5.4; TRD = 15.9, p < 0.001). Conclusions In conclusion, TRD patients had significantly lower quality of life, greater work productivity and activity impairment, and increased healthcare resource utilization as compared with nTRD and general population. The study findings suggest an unmet need exists among TRD patients in Europe. Electronic supplementary material The online version of this article (10.1186/s12888-019-2222-4) contains supplementary material, which is available to authorized users.

Practical recommendations for the management of treatment-resistant depression with esketamine nasal spray therapy: Basic science, evidence-based knowledge and expert guidance

“…The characteristics and symptomatology of the current depressive episode can exacerbate the persistence and recurrence of TRD. These include the severity and duration of the current depressive episode, early age of onset (Bennabi et al 2019), melancholic features (Jaffe et al 2019) or suicidal risk (Souery et al 2007), the latter of which is thought to be associated with Val66Met and rs10501087 polymorphisms (Schosser et al 2017). The patient's disease and treatment history may also impact the risk of TRD, for example, childhood adversity (Tunnard et al 2014), number of prior depressive episodes (Bartova et al 2019), traumatic or stressful life events, or previous non-remission or partial remission (Murphy et al 2017).…”

A retrospective chart review study to quantify the monthly medical resource use and costs of treating patients with treatment resistant depression in the United Kingdom

“…Compared with those patients with MDD who respond to treatment, patients with TRD contribute a disproportionately high impact, including a higher number of depressive episodes, more frequent relapses or recurrence of their depression, increased suicidality, a higher risk of comorbidities, and a decrease in daily functioning and health-related quality of A c c e p t e d M a n u s c r i p t life. [12,[15][16][17][18] Accordingly, the treatment of patients with TRD is associated with an increase in healthcare resource utilisation (HCRU) and economic cost, due to a higher number of visits to both primary and secondary care practitioners, a higher rate of hospitalisations, and more psychiatric prescriptions including anxiolytics, hypnotics and antipsychotics. [17,19,20] Despite a recent systematic literature review highlighting the association between treatment resistance within a major depressive episode (MDE) and reduced patient quality of life and health status, methodological and population differences limit the ability to meaningfully compare or synthesize results across the studies.…”

Lower serum 25-hydroxycholecalciferol is associated with depressive symptoms in older adults in Southern Brazil

“…Another interesting finding in our study was that 21.4% (P = 0.048) of older individuals who used antidepressant drugs were classified as having depressive symptoms. Some studies discussed that around 10-30% of individuals with depression presented resistance in drug therapy, not responding to treatment with at least two antidepressants [9,[83][84][85]. Alternatively, the available antidepressants are commonly accompanied by unpleasant side effects and may cause treatment to be discontinued [33].…”