Identifying Treatment Resistant Depression Earlier Lowers Risk Of Death

In a recent study published in JAMA Psychiatry, researchers warn that people who suffer from episodes of treatment resistant depression have a far higher prevalence of psychiatric co-morbidities compared to those who only have major depressive disorder (MDD). That means, those who have treatment resistant depression are three times more likely to be hospitalized and might also face a 23% higher risk of death.

A 2018 Lancet study found that major depressive disorder surpasses several diseases and even injuries as the leading cause of disability globally. Psychiatrists and other physicians prescribe antidepressants and advice those with major depressive disorder to undergo psychotherapy. Some experience relief from depressive episodes within a few months or years. “But a substantial number of patients do not experience a reduction in symptoms after several months and numerous treatment attempts,” the researchers wrote in the JAMA Psychiatry study.

A person can be diagnosed with treatment resistant depression if there is no remission of depressive episodes even after completing two or more antidepressant regimens with adequate dosages for a certain duration. In a 2006 study, researchers estimated that more than 30% of people with major depressive disorder could have treatment resistant depression episodes.

“Prognostic factors for responding to the first, second, or third treatment trial, which could aid clinicians in identifying patients in need of more intense monitoring, interventions, and support, have not yet been established,” the researchers added.

The Sweden-based team used data from Stockholm’s administrative healthcare database and the Swedish Social Insurance Agency. More than 145,000 people who were experiencing symptoms of major depressive disorder from 2012 to 2017 were included in the study. Out of these, 110,115 people had undergone one or more antidepressant treatments. Only 12,765 or 11.1% of the entire cohort were diagnosed with treatment resistant depression.

“Patients with treatment resistant depression episodes were more prone to increased health care resource utilization, anxiety, stress, self-harm, and lost workdays and had a more than 50% higher mean number of outpatient physician visits,” the researchers observed.

Around 60% of the study’s participants were prescribed SSRIs as the first line of treatment. The most common antidepressants that patients were resistant to were mirtazapine, bupropion, escitalopram, and venlafaxine. On average, it took a year and a half for people with treatment resistant depression to complete two treatment attempts. However, that is several months longer than what researchers recommend for determining the efficacy of a treatment regimen.

In a press release, Johan Lundberg, adjunct professor at the Northern Stockholm Psychiatry Clinic, said: “We’re talking about a patient group with a substantial health care consumption that might be identified earlier than today by increasing the use of symptom severity rating scales. Going by the results of the study, their care and treatment could be improved if their physician replaced ineffective treatments more rapidly and more often used treatments recommended for treatment resistant depression, such as lithium, than was the case in the study material.”

“We would benefit from identifying patients at risk of developing treatment resistant depression, since it causes a great deal of personal suffering and is a burden for the whole of society,” added Lundberg.