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 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 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

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 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 Critical review of available treatment options for treatment refractory depression and anxiety - clinical and ethical dilemmas

2016 ◽  
Vol 69 (5-6) ◽  
pp. 171-176 ◽  
Author(s):  
Dusan Kolar ◽  
Michael Kolar
Keyword(s):  
Anxiety Disorders ◽  
Ethical Dilemmas ◽  
Treatment Options ◽  
Depression And Anxiety ◽  
Treatment Resistant Depression ◽  
Treatment Resistant ◽  
Symptoms Of Depression ◽  
Mood And Anxiety Disorders ◽  
Resistant Depression ◽  
Treatment Refractory

Treatment-resistant mood and anxiety disorders require an intensive therapeutic approach, and it should balance benefits and adverse effects or other potential detrimental effects of medications. The goal of treatment is to provide consistent and lasting improvement in symptoms of depression and anxiety. Benzodiazepines are effective for anxiety symptoms, but with no sustained treatment effects. Other medication treatment options for anxiety disorders are outlined. Ketamine is usually very effective in treating major depressive disorder but without sustained benefits. Long-term use may pose a significant risk of developing tolerance and dependence. Stimulant medication augmentation for treatment-resistant depression is effective for residual symptoms of depression, but effects are usually short-lasting and it sounds more as an artificial way of improving energy, alertness and cognitive functioning. Synthetic cannabinoids and medical marijuana are increasingly prescribed for various medical conditions, but more recently also for patients with mood and anxiety disorders. All of these treatments may raise ethical dilemmas about appropri?ateness of prescribing these medications and a number of questions regarding the optimal treatment for patients with treatment-resistant depression and treatment refractory anxiety disorders.

Emerging Treatment Options in Treatment-Resistant Depression and Anxiety Disorders

CNS Spectrums ◽  
2002 ◽  
Vol 9 (S14) ◽  
pp. 25-32
Author(s):  
Waguih William IsHak ◽  
Mark H. Rapaport ◽  
Jennifer G. Gotto
Keyword(s):  
Anxiety Disorders ◽  
Treatment Options ◽  
Management Strategies ◽  
Treatment Strategies ◽  
Depression And Anxiety ◽  
Treatment Resistant Depression ◽  
Treatment Resistant ◽  
Augmentation Strategies ◽  
Resistant Depression ◽  
New Treatment

ABSTRACTManagement strategies for treatment-resistant depression and anxiety disorders have evolved over the last decade. Our understanding of the factors that impair recovery from an episode of major depression has increased, leading to the development of more precise diagnostic methodology that highlight the presence of comorbid conditions. New medications, creative uses of existing medications, increased empirical data about augmentation strategies, and the development of innovative nonpharmacologic interventions are responsible for a marked expansion in treatment options. Traditionally, augmentations with lithium, thyroid hormones, or electroconvulsive therapy have demonstrated effectiveness in some patients with treatment-resistant mood disorders. Among the promising treatments in both depression and anxiety is augmentation using low-dose antipsychotics medications, combining antidepressants of different classes, and the addition of psychotherapy. Nonpharmacologic interventions that may have potential include transcranial magnetic stimulation, deep-brain stimulation, and vagus-nerve stimulation. This article provides a brief review of the available data summarizing existing and new treatment strategies in depression and anxiety disorders.

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