A report in JAMA Psychiatry has found that among patients with major depressive disorder (MDD), those with treatment-resistant depression (TRD) have higher risks of psychiatric comorbidities, health care use, death, and self-harm. The patients were considered to have TRD if they continued to have symptoms of depression after three different treatments.
“We show that having TRD was associated with a more than 20% increase in all-cause mortality, which is in alignment with previous studies,” wrote Johan Lundberg, M.D., Ph.D., of the Karolinska Institutet in Stockholm and colleagues. “Although causes of death were not investigated, we found that factors closely linked to risk of suicide, such as self-harm, were higher in patients with TRD, especially during the year following the index date [the start of their third treatment trial].”
The researchers identified all recorded MDD episodes that started between January 1, 2012, and December 31, 2017, among individuals aged 18 years or older who lived in the Stockholm region. These episodes were then categorized as either TRD (3 or more treatment trials of an antidepressant, an add-on medication, electroconvulsive therapy, or repetitive transcranial magnetic stimulation) or non-TRD. The start of each TRD episode was the date that the third treatment trial was initiated.
A total of 158,169 MDD episodes (145,577 patients) were identified. Of these, 12,793 episodes (12,765 patients) fulfilled TRD criteria. The authors found the following:
- Patients with MDD experiencing a TRD episode were 1.23 times more likely to die of any cause than those with MDD who did not experience a TRD episode.
- Patients with TRD had an average of 3.9 inpatient hospital days and 132.3 lost workdays in the year following their diagnosis compared with 1.3 inpatient hospital days and 58.7 lost workdays for non-TRD patients, respectively.
- Intentional self-harm was more than 4 times more common in patients with TRD.
Using a secondary sample of all MDD episodes from January 2015 through December 2017, the researchers also examined variables that might predict TRD. The most important predictive factor was severity of depression, as rated on the Montgomery-Åsberg Depression Rating Scale (MADRS).
“Our finding that the risk of subsequent TRD can be assessed by severity could help clinicians identify at first MDD diagnosis the patients in need of closer follow-up,” the researchers stated.
For related information, see the Psychiatric News article “Effective Next Step Treatments Identified for Refractory Depression.”
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