scholarly journals Treatment-Resistant Depression and Major Depression With Suicide Risk – The Cost of Illness and Burden of Disease

2021 ◽  
Author(s):  
Rute Dinis Sousa ◽  
Miguel Gouveia ◽  
Catarina Nunes-da-Silva ◽  
Ana Rodrigues ◽  
Graça Cardoso ◽  
...  
Keyword(s):  
Major Depression ◽  
Burden Of Disease ◽  
Suicide Risk ◽  
Disease Burden ◽  
Indirect Costs ◽  
Premature Death ◽  
Direct Costs ◽  
Treatment Resistant Depression ◽  
Treatment Resistant ◽  
Resistant Depression

Abstract Introduction: Treatment-Resistant Depression (TRD) and Major Depression with Suicide Risk (MDSR) are types of depression with relevant effects on the health of the population and a potentially significant economic impact. This study estimates the burden of disease and the costs of illness attributed to Treatment-Resistant Depression and Major Depression with Suicide Risk in Portugal.Methods: The disease burden for adults was quantified in 2017 using the Disability-Adjusted Life Years (DALYs) lost. Direct costs related to the health care system and indirect costs were estimated for 2017, with indirect costs resulting from the reduction in productivity. Estimates were based on multiple sources of information, including the National Epidemiological Study on Mental Health, the Hospital Morbidity Database, data from the Portuguese National Statistics Institute on population and causes of death, official data on wages, statistics on the pharmaceutical market, and qualified opinions of experts.Results: The estimated prevalence of TRD, MDSR, and both types of depression combined was 79.4 thousand, 52.5 thousand, and 11.3 thousand patients, respectively. The disease burden (DALY) due to the disability generated by TRD alone, MDSR alone, and the joint prevalence was 25.2 thousand, 21 thousand, and 4.5 thousand respectively, totaling 50.7 thousand DALYs. The disease burden due to premature death by suicide was 15.6 thousand DALYs. The estimated total disease burden was 66.3 thousand DALYs.In 2017, the annual direct costs with TRD and MDSR were estimated at € 30.8 million, with the most important components being medical appointments and medication. The estimated indirect costs were much higher than the direct costs. Adding work productivity losses due to reduced employment, absenteeism, presenteeism, and premature death, a total cost of € 1,1 billion was obtained.Conclusions: Although TRD and MDSR represent relatively small direct costs for the health system, they have a relevant disease burden and extremely substantial productivity costs for the Portuguese economy and society, making TRD and MDSR priority areas for achieving health gains.

Toward Optimal Treatments for Major Depression

CNS Spectrums ◽  
2002 ◽  
Vol 7 (2) ◽  
pp. 148-154 ◽  
Author(s):  
Pierre Blier ◽  
Herbert Ward
Keyword(s):  
Major Depression ◽  
Therapeutic Response ◽  
Antidepressant Drug ◽  
Treatment Resistant Depression ◽  
Antidepressant Response ◽  
Controlled Clinical Trials ◽  
Treatment Resistant ◽  
Ongoing Research ◽  
Resistant Depression ◽  
First And Second Generation

ABSTRACTThe treatment of major depression remains problematic for several reasons. In particular, the therapeutic response to medications usually does not manifest itself until a week after administration has begun, and more than half the patients will not experience a full recovery with the first antidepressant drug administration. There are, however, some pharmacologic strategies that can accelerate antidepressant response. When facing a treatment-resistant depression, combination therapy offers a more time-efficient approach to achieve remission than drug substitution. These interventions have been devised on a better understanding of the basis for the therapeutic response obtained with the first- and second-generation antidepressants, and evidence derived from controlled clinical trials of their superior effectiveness is growing. The rationale for such approaches will be described in this article, as well as their advantages and potential inconveniences. Ongoing research in this field continues to fuel the development of novel, better-tolerated, and more effective pharmacotherapies for depression.

scholarly journals A Review of the Conceptualisation and Risk Factors Associated with Treatment-Resistant Depression

2017 ◽  
Vol 2017 ◽  
pp. 1-10 ◽  
Author(s):  
Jenifer A. Murphy ◽  
Jerome Sarris ◽  
Gerard J. Byrne
Keyword(s):  
Major Depression ◽  
Poor Response ◽  
Clinical Problem ◽  
Treatment Resistant Depression ◽  
Treatment Resistant ◽  
Rank One ◽  
System Activation ◽  
Resistant Depression ◽  
Staging Model ◽  
Inflammatory System

Major depression does not always remit. Difficult-to-treat depression is thought to contribute to the large disease burden posed by depression. Treatment-resistant depression (TRD) is the conventional term for nonresponse to treatment in individuals with major depression. Indicators of the phenomenon are the poor response rates to antidepressants in clinical practice and the overestimation of the efficacy of antidepressants in medical scientific literature. Current TRD staging models are based on anecdotal evidence without an empirical rationale to rank one treatment strategy above another. Many factors have been associated with TRD such as inflammatory system activation, abnormal neural activity, neurotransmitter dysfunction, melancholic clinical features, bipolarity, and a higher traumatic load. This narrative review provides an overview of this complex clinical problem and discusses the reconceptualization of depression using an illness staging model in line with other medical fields such as oncology.

scholarly journals The Efficacy of Buprenorphine in Major Depression, Treatment-Resistant Depression and Suicidal Behavior: A Systematic Review

2018 ◽  
Vol 19 (8) ◽  
pp. 2410 ◽  
Author(s):  
Gianluca Serafini ◽  
Giulia Adavastro ◽  
Giovanna Canepa ◽  
Domenico De Berardis ◽  
Alessandro Valchera ◽  
...  
Keyword(s):  
Major Depression ◽  
Suicidal Behavior ◽  
Depression Treatment ◽  
Treatment Resistant Depression ◽  
Long Term Effects ◽  
Treatment Resistant ◽  
Refractory Depression ◽  
Research Findings ◽  
Resistant Depression

Although several pharmacological options to treat depression are currently available, approximately one third of patients who receive antidepressant medications do not respond adequately or achieve a complete remission. Thus, novel strategies are needed to successfully address those who did not respond, or partially respond, to available antidepressant pharmacotherapy. Research findings revealed that the opioid system is significantly involved in the regulation of mood and incentives salience and may be an appropriate target for novel therapeutic agents. The present study aimed to systematically review the current literature about the use of buprenorphine (BUP) for major depression, treatment-resistant depression (TRD), non-suicidal self-injury (NSSI) behavior, and suicidal behavior. We investigated Pubmed and Scopus databases using the following keywords: “buprenorphine AND depression”, “buprenorphine AND treatment resistant depression”, “buprenorphine AND suicid*”, “buprenorphine AND refractory depression”. Several evidence demonstrate that, at low doses, BUP is an efficacious, well-tolerated, and safe option in reducing depressive symptoms, serious suicidal ideation, and NSSI, even in patients with TRD. However, more studies are needed to evaluate the long-term effects, and relative efficacy of specific combinations (e.g., BUP + samidorphan (BUP/SAM), BUP + naloxone (BUP/NAL), BUP + naltrexone) over BUP monotherapy or adjunctive BUP treatment with standard antidepressants, as well as to obtain more uniform guidance about the optimal BUP dosing interval.

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