Treatment-Resistant Depression in Poland—Epidemiology and Treatment

Abstract

(1) Background: Major depressive disorder (MDD) is one of the most prevalent psychiatric disorders worldwide. Although several antidepressant drugs have been developed, up to 30% of patients fail to achieve remission, and acute remission rates decrease with the number of treatment steps required. The aim of the current project was to estimate and describe the population of treatment-resistant depression (TRD) patients in outpatient clinics in Poland. (2) Methods: The project involved a representative sample of psychiatrists working in outpatient clinics, chosen through a process of quota random sampling. The doctors completed two questionnaires on a consecutive series of patients with MDD, which captured the patients’ demographics, comorbidities, and medical histories. TRD was defined as no improvement seen after a minimum of two different antidepressant drug therapies applied in sufficient doses for a minimum of 4 weeks each. The data were weighted and extrapolated to the population of TRD outpatients in Poland. (3) Results: A total of 76 psychiatrists described 1781 MDD patients, out of which 396 fulfilled the criteria of TRD. The TRD patients constituted 25.2% of all MDD patients, which led to the number of TRD outpatients in Poland being estimated at 34,800. The demographics, comorbidities, medical histories, and histories of treatment of Polish TRD patients were described. In our sample of the TRD population (mean age: 45.6 ± 13.1 years; female: 64%), the patients had experienced 2.1 ± 1.6 depressive episodes (including the current one), and the mean duration of the current episode was 4.8 ± 4.4 months. In terms of treatment strategies, most patients (around 70%) received monotherapy during the first three therapies, while combination antidepressant drugs (ADs) were applied more often from the fourth line of treatment. The use of additional medications and augmentation was reported in only up to one third of the TRD patients. During all of the treatment steps, patients most often received a selective serotonin reuptake inhibitor (SSRI) and a serotonin norepinephrine reuptake inhibitor (SNRI). (4) Conclusions: TRD is a serious problem, affecting approximately one fourth of all depressive patients and nearly 35,000 Poles.

Genetic and epigenetic factors associated with depression: An updated overview

“…Many drugs are available for the treatment of depression with different ways of action as: Typical antidepressants, Selective serotonin reuptake inactivators, serotonin/norepinephrine reuptake inhibitors, Serotonin-Dopamine Activity Modulators, Monoamine oxidase inhibitors, and Tricyclic antidepressants ( Bennabi et al, 2019 , Gałecki et al, 2022 ).…”

“…As a result, the following are some of the indications for using ECT: a fast antidepressant reaction is required as drug therapy has failed, patient inclination, suicide risk is predicted, ECT has a strong track record in the past, the hazard of medical therapy. Although developments in brief anesthesia and neuromuscular paralysis have progressed ECT's safety and tolerability, treatment still has several hazards, including those related to general anesthesia, postictal disorientation, and, in rare cases, short-term memory problems ( Bennabi et al, 2019 , Gałecki et al, 2022 ).…”

“…Evidence-based psychotherapies like Cognitive Behavior Therapy and Interpersonal Therapy have been demonstrated to be potent in depression treatment ( Gałecki et al, 2022 ).…”

“…Patients with depression have cognitive distortions that aid in the maintenance of their negative views. CBT for depression usually consists of behavioral methods (such as activity scheduling) and cognitive restructuring to shift automatic negative thinking and address maladaptive schemas ( Gałecki et al, 2022 ).…”

“…The MBCT program focuses on ruminative mental processes as a relapse hazard factor. MBCT appears to help reduce the likelihood of relapse in cases with repeated depression, particularly in those with the most severe remaining signs ( Caraci et al, 2018 , Gałecki et al, 2022 ).…”