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

2020 ◽  
Author(s):  
Shiau-Shian Huang ◽  
Hsi-Han Chen ◽  
Jui Wang ◽  
Wei J. Chen ◽  
Hsi-Chung Chen ◽  
...  
Keyword(s):  
Anxiety Disorder ◽  
Clinical Features ◽  
Cox Regression ◽  
Treatment Resistant Depression ◽  
Treatment Resistant ◽  
Psychiatric Comorbidities ◽  
Prescription Patterns ◽  
Increased Risk ◽  
Resistant Depression ◽  
Depressive Patients

Abstract Background To investigate the risk of developing treatment-resistant depression among depressive patients by examining clinical features, early prescription patterns, and early and lifetime comorbidities. Methods A total of 31,422 depressive inpatients were followed from diagnostic onset to more than ten-years. treatment-resistant depression was defined by altered antidepressant treatment regimens more than twice or being admitted after received at least two antidepressant treatments. Multiple regression and Cox regression models were used to examine the effects of physical and psychiatric comorbidities, psychosis, and early prescription patterns on the risk of developing treatment-resistant depression. Results Female depressive patients (21.24%) were more likely to become treatment-resistant depression than males (14.02%). Early anxiety disorder was commonly observed in the treatment-resistant depression comparing with non-treatment-resistant depression groups (81.48 vs. 58.96%, p < 0.0001). Lifetime anxiety disorder exhibited the highest population attributable fraction (43.1%). 70% of patients with multiple psychiatric comorbidities developed treatment-resistant depression during follow-up. Results in Cox regression further identified that functional gastrointestinal disorders significantly increased the risk of treatment-resistant depression (aHR = 1.18). A higher dose of antidepressants in early disease course exhibited increased risk for treatment-resistant depression (p < 0.0001). Conclusion Our findings indicate the need to monitor early comorbidities and polypharmacy patterns in patients with major depressive disorder that are associated with an elevated risk for treatment-resistant depression.

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

2020 ◽  
Author(s):  
Shiau-Shian Huang ◽  
Hsi-Han Chen ◽  
Jui Wang ◽  
Wei J. Chen ◽  
Hsi-Chung Chen ◽  
...  
Keyword(s):  
Anxiety Disorders ◽  
Clinical Features ◽  
Cox Regression ◽  
Functional Gastrointestinal Disorders ◽  
Treatment Resistant Depression ◽  
Treatment Resistant ◽  
Psychiatric Comorbidities ◽  
Cox Regression Analysis ◽  
Prescription Patterns ◽  
Resistant Depression

Abstract Background: To investigate the risk of treatment-resistant depression (TRD) in patients with depression by examining their clinical features, early prescription patterns, and early and lifetime comorbidities. Methods: In total, 31,422 depressive inpatients were followed-up from diagnostic onset for more than 10-years. Patients were diagnosed with TRD if their antidepressant treatment regimen was altered ≥two times or if they were admitted after at least two different antidepressant treatments. Multiple Cox regression model were used to determine whether physical and psychiatric comorbidities, psychosis, and prescription patterns increased the risk of TRD by controlling for relevant demographic covariates. Survival analyses were performed for important TRD-associated clinical variables. Results: Females with depression (21.24%) were more likely to suffer from TRD than males (14.02%). Early anxiety disorders were more commonly observed in the TRD group than in the non-TRD group (81.48 vs. 58.96%, p<0.0001). Lifetime anxiety disorders had the highest population attributable fraction (42.87%). Seventy percent of patients with multiple psychiatric comorbidities developed TRD during follow-up. Cox regression analysis further identified that functional gastrointestinal disorders significantly increased TRD risk (aHR=1.19). Higher doses of antidepressants and benzodiazepines and Z drugs in the early course of major depressive disorder increased TRD risk (p<0.0001). Conclusion: Our findings indicate the need to monitor early comorbidities and polypharmacy patterns in patients with depression associated with elevated TRD risk.

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

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Shiau-Shian Huang ◽  
Hsi-Han Chen ◽  
Jui Wang ◽  
Wei J. Chen ◽  
Hsi-Chung Chen ◽  
...  
Keyword(s):  
Anxiety Disorders ◽  
Clinical Features ◽  
Cox Regression ◽  
Functional Gastrointestinal Disorders ◽  
Treatment Resistant Depression ◽  
Treatment Resistant ◽  
Psychiatric Comorbidities ◽  
Cox Regression Analysis ◽  
Prescription Patterns ◽  
Resistant Depression

Abstract Background To investigate the risk of treatment-resistant depression (TRD) in patients with depression by examining their clinical features, early prescription patterns, and early and lifetime comorbidities. Methods In total, 31,422 depressive inpatients were followed-up from diagnostic onset for more than 10-years. Patients were diagnosed with TRD if their antidepressant treatment regimen was altered ≥two times or if they were admitted after at least two different antidepressant treatments. Multiple Cox regression model were used to determine whether physical and psychiatric comorbidities, psychosis, and prescription patterns increased the risk of TRD by controlling for relevant demographic covariates. Survival analyses were performed for important TRD-associated clinical variables. Results Females with depression (21.24%) were more likely to suffer from TRD than males (14.02%). Early anxiety disorders were more commonly observed in the TRD group than in the non-TRD group (81.48 vs. 58.96%, p < 0.0001). Lifetime anxiety disorders had the highest population attributable fraction (42.87%). Seventy percent of patients with multiple psychiatric comorbidities developed TRD during follow-up. Cox regression analysis further identified that functional gastrointestinal disorders significantly increased TRD risk (aHR = 1.19). Higher doses of antidepressants and benzodiazepines and Z drugs in the early course of major depressive disorder increased TRD risk (p < 0.0001). Conclusion Our findings indicate the need to monitor early comorbidities and polypharmacy patterns in patients with depression associated with elevated TRD risk.

scholarly journals Treatment-Resistant Depression in Adolescents: Clinical Features and Measurement of Treatment Resistance

2020 ◽  
Vol 30 (4) ◽  
pp. 261-266 ◽  
Author(s):  
Jeffrey R. Strawn ◽  
Scott T. Aaronson ◽  
Ahmed Z. Elmaadawi ◽  
G. Randolph Schrodt ◽  
Richard C. Holbert ◽  
...  
Keyword(s):  
Clinical Features ◽  
Treatment Resistance ◽  
Treatment Resistant Depression ◽  
Treatment Resistant ◽  
Resistant Depression

scholarly journals Pharmacological Treatments for Patients with Treatment-Resistant Depression

2020 ◽  
Vol 13 (6) ◽  
pp. 116 ◽  
Author(s):  
Valerie L. Ruberto ◽  
Manish K. Jha ◽  
James W. Murrough
Keyword(s):  
Treatment Options ◽  
Symptom Relief ◽  
Antidepressant Medication ◽  
Treatment Resistant Depression ◽  
Treatment Resistant ◽  
Qualitative Synthesis ◽  
Course Of Illness ◽  
Effective Strategies ◽  
Increased Risk ◽  
Resistant Depression

Over a third of patients with major depressive disorder (MDD) do not have an adequate response to first-line antidepressant treatments, i.e., they have treatment-resistant depression (TRD). These patients tend to have a more severe course of illness and are at an increased risk of suicide. Next step treatment options for patients with TRD, include switching to a different antidepressant, combining more than one antidepressant, or augmenting an antidepressant with another (non-antidepressant) medication. It is unclear which of these treatment approaches should be applied to a given patient, and in what order. Due to this ambiguity, comparing antidepressants and augmentation agents on the basis of their efficacy, tolerability, and speed of symptom relief would be beneficial for clinicians. To accomplish this, a systematic search was conducted following PRISMA guidelines. Only randomized controlled trials were included in this qualitative synthesis, resulting in 66 articles. This review identified several effective pharmaco-therapeutic strategies that are currently available for patients with TRD. Ketamine and esketamine appear to be effective for the treatment of TRD. Augmentation with certain second generation antipsychotics, such as quetiapine or aripiprazole is likewise effective, and may be preferred over switching to antidepressant monotherapy. While the combination of olanzapine and fluoxetine was one of the first pharmacotherapy approved for TRD, and its use may be limited by metabolic side-effects. Other effective strategies include augmentation with lithium, liothyronine (T3), lamotrigine, or combination of antidepressants including bupropion, tricyclics, or mirtazapine. There is insufficient research to demonstrate the efficacy of ziprasidone or levothyroxine (T4). A shared decision-making approach is recommended to guide treatment selection to address each patient’s individual needs.

Association of clinical features and biomarkers with treatment-resistant depression

2020 ◽  
Vol 36 ◽  
pp. 32-38
Author(s):  
Ana Carolina Congio ◽  
Maisa Norcia ◽  
Mariana Ragassi Urbano ◽  
Waldiceu A. Verri ◽  
Sandra Odebrecht Vargas Nunes
Keyword(s):  
Clinical Features ◽  
Treatment Resistant Depression ◽  
Treatment Resistant ◽  
Resistant Depression

scholarly journals Clinical characteristics of treatment-resistant depression in adults in Hungary: Real-world evidence from a 7-year-long retrospective data analysis

PLoS ONE ◽  
2021 ◽  
Vol 16 (1) ◽  
pp. e0245510
Author(s):  
Péter Döme ◽  
Péter Kunovszki ◽  
Péter Takács ◽  
László Fehér ◽  
Tamás Balázs ◽  
...  
Keyword(s):  
Cerebrovascular Diseases ◽  
Poor Quality ◽  
Treatment Resistant Depression ◽  
Treatment Resistant ◽  
Retrospective Data Analysis ◽  
Real World Evidence ◽  
Increased Risk ◽  
Autoimmune Conditions ◽  
Resistant Depression ◽  
Using Data

Purpose Treatment-resistant depression (TRD) is associated with a poor quality of life and high economic burden. This observational retrospective epidemiological study aimed to estimate the proportion of patients with TRD within a cohort of patients with major depressive disorder (MDD) in Hungary and examine the mortality and comorbidities of patients with and without TRD. Patients and methods This study included patients with MDD who experienced onset of a new depressive episode between 01 January 2009 and 31 August 2015, using data from a nationwide, longitudinal database. Results Overall, 99,531 patients were included in the MDD cohort, of which 8,268 (8.3%) also met the criteria for TRD. The overall survival of non-TRD patients was longer than in TRD patients; the risk of mortality for TRD patients was significantly higher than of non-TRD patients (HR [CI] 1.381 [1.212–1.571]; p<0.001). Patients with TRD had a significantly higher probability of having “Neurotic, stress-related and somatoform disordersˮ, autoimmune conditions, cardio- or cerebrovascular diseases, thyroid gland diseases and self-harming behaviour not resulting in death than non-TRD patients (for all comparisons, p values were less than 0.005). Discussion To our best knowledge, this is the first study to assess the frequency of TRD in Hungary. In a cohort of Hungarian MDD patients, we have found that the proportion of TRD (~8.3%) is comparable to those reported in previous studies with similar methodology from other countries. The majority of our other main findings (e.g. more frequent self-harming behaviour, increased risk of “Neurotic, stress-related and somatoform disordersˮ and higher overall mortality in TRD subjects) are also in line with previous results from other countries. Taking the substantial proportion of patients with TRD into consideration, a more comprehensive and targeted treatment strategy would be required for these individuals.

scholarly journals Early labor force exits in patients with treatment-resistant depression: an assessment of work years lost in a Danish nationwide register-based cohort study

2020 ◽  
Vol 10 ◽  
pp. 204512532097379
Author(s):  
Kathrine Bang Madsen ◽  
Liselotte Vogdrup Petersen ◽  
Oleguer Plana-Ripoll ◽  
Katherine L. Musliner ◽  
Jean-Christophe Philippe Debost ◽  
...  
Keyword(s):  
Labor Force ◽  
Disability Pension ◽  
Cox Regression ◽  
Age Groups ◽  
Treatment Resistance ◽  
Total Sample ◽  
Treatment Resistant Depression ◽  
Treatment Resistant ◽  
Somatic Comorbidity ◽  
Resistant Depression

Background: Depression is one of the leading causes of premature workforce exit in many Western countries, but little is known about the extent to which treatment-resistance reduces number of work-years. We compared the risk of premature workforce exit among patients with treatment-resistant depression (TRD) relative to non-TRD patients and estimated work years lost (WYL) before scheduled retirement age. Methods: The study population, identified in the Danish National Prescription Registry, included all individuals born and living in Denmark who redeemed their first antidepressant (AD) prescription for depression at age 18–60 years between 2005 and 2012. TRD was defined as failure to respond to at least two different treatment trials. Premature workforce exit was measured using disability pension records. We used Cox regression to estimate the hazard ratio (HR) for premature workforce exit in TRD relative to non-TRD patients, adjusting for calendar year, psychiatric and somatic comorbidity, and educational level. Differences in WYL in patients with TRD and all depression patients were estimated through a competing risks model. Results: Out of the total sample of patients with depression ( N = 129,945), 7478 (5.75%) were classified as having TRD. During follow up, 17% of patients with TRD and 8% of non-TRD patients received disability pension, resulting in a greater than three-fold larger risk of premature workforce exit [adjusted HR (aHR) 3.23 95% confidence interval (CI) 3.05–3.43]. The TRD group lost on average six work-years (95% CI 5.64–6.47) more than the total sample due to early labor force exit. The association between TRD and age at premature workforce exit was inversely U-shaped; the hazard rate of premature workforce exit for patients with TRD compared with non-TRD patients was highest in the age groups 31–35, 36–40, and 41–45 years. Conclusion: Patients with TRD constitute a small group within depression patients, but contribute disproportionally to societal costs due to premature workforce exit at a young age.

scholarly journals The Impact of Childhood Maltreatment on Intravenous Ketamine Outcomes for Adult Patients with Treatment-Resistant Depression

2019 ◽  
Vol 12 (3) ◽  
pp. 133 ◽  
Author(s):  
O’Brien ◽  
Lijffijt ◽  
Wells ◽  
Swann ◽  
Mathew
Keyword(s):  
Treatment Response ◽  
Childhood Trauma ◽  
Childhood Maltreatment ◽  
Treatment Resistant Depression ◽  
Treatment Resistant ◽  
Increased Risk ◽  
Resistant Depression ◽  
Clinically Significant ◽  
The Impact ◽  
Intravenous Ketamine

Childhood maltreatment is associated with a poor treatment response to conventional antidepressants and increased risk for treatment-resistant depression (TRD). The N-methyl-D-aspartate receptor (NDMAR) antagonist ketamine has been shown to rapidly improve symptoms of depression in patients with TRD. It is unknown if childhood maltreatment could influence ketamine’s treatment response. We examined the relationship between childhood maltreatment using the Childhood Trauma Questionnaire (CTQ) and treatment response using the Quick Inventory of Depressive Symptoms–Self Report (QIDS-SR) in TRD patients receiving intravenous ketamine at a community outpatient clinic. We evaluated treatment response after a single infusion (n = 115) and a course of repeated infusions (n = 63). Repeated measures general linear models and Bayes factor (BF) showed significant decreases in QIDS-SR after the first and second infusions, which plateaued after the third infusion. Clinically significant childhood sexual abuse, physical abuse, and cumulative clinically significant maltreatment on multiple domains (maltreatment load) were associated with better treatment response to a single and repeated infusions. After repeated infusions, higher load was also associated with a higher remission rate. In contrast to conventional antidepressants, ketamine could be more effective in TRD patients with more childhood trauma burden, perhaps due to ketamine’s proposed ability to block trauma-associated behavioral sensitization.

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