Summary: A study reveals that people with treatment-resistant depression have a 23% higher risk of death than people without the condition.
Font: Karolinska Institute
Patients with treatment-resistant depression have a 23 percent higher risk of death than other depressed patients. They also get twice the amount of outpatient care and spend triple the number of days in hospital care. These are the findings of a new study published in JAMA Psychiatry by Karolinska researchers Institute and elsewhere, who conclude that it is important to identify patients at risk of developing treatment-resistant depression.
Depression is the leading cause of functional disability worldwide. The most common treatments are antidepressants or psychotherapy. Many patients need care for months or years, but a significant portion of patients never recover despite two well-implemented attempts at treatment. They have what is commonly called treatment-resistant depression.
Researchers from the Karolinska Institutet and the Center for Psychiatric Research have now examined the effects of treatment-resistant depression in the Stockholm region at both the individual and societal levels, something that has not been studied to the same extent before.
In the population-based observational study, the researchers used data from several sources, including the Stockholm Region Administrative Healthcare Database and the Swedish Social Insurance Agency. More than 145,000 patients with depression in the Stockholm region were included in the study.
Having identified 158,000 depressive episodes in these patients between 2012 and 2017, of which more than 12,000 were treatment-resistant in nature, the researchers were able to draw a number of conclusions about what characterizes patients with treatment-resistant depression.
“We found that the treatment-resistant group used twice as many outpatient resources, had twice the sick leave, spent three times as many days in the hospital, and had a 23 percent higher mortality rate than patients with treatment-responsive depression. treatment”. says Johan Lundberg, assistant professor of psychiatry in the Department of Clinical Neuroscience and head of the section for mood disorders at the North Stockholm Clinic for Psychiatry.
They also found greater comorbidity with other psychiatric conditions, such as anxiety syndrome, insomnia, substance abuse syndrome, and self-harm in the group with treatment-resistant depression.
The researchers found that the risk of developing treatment-resistant depression could already be predicted at the first diagnosis of depression. By far the most important prognostic factor was self-rated depression severity.
“It would benefit us to identify patients at risk of developing treatment-resistant depression, as it causes a lot of personal suffering and is a burden on the whole of society,” says Professor Johan Lundberg.
Patients with treatment-resistant depression took an average of 1.5 years to undergo the two treatment attempts, several months longer than is recommended to assess the effectiveness of a treatment for depression.
Professor Lundberg says that more frequent replacement of ineffective treatments would probably be of great help for this group of patients.
“We are talking about a group of patients with substantial healthcare consumption that could be identified earlier than today by increasing the use of symptom severity rating scales.
“Based on the study results, your care and treatment could be improved if your doctor replaced ineffective treatments more quickly and used recommended treatments for treatment-resistant depression, such as lithium, more frequently than was the case in the study material.” , He says. Professor Lundberg.
Money: The study was initiated and funded by the Stockholm Region and carried out in association with the pharmaceutical company Janssen-Cilag.
About this depression research news
Author: press office
Font: Karolinska Institute
Contact: Press Office – Karolinska Institute
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original research: Open access.
“Treatment-resistant depression: epidemiology, consequences, and associations: a population-wide study.” by Johan Lundberg et al. JAMA Psychiatry
Summary
Treatment-resistant depression: epidemiology, consequences, and associations: a population-wide study.
Importance
The full societal and individual impact of treatment-resistant depression (TRD) is unknown, as is the potential to predict TRD. The generalizability of many observational studies on TRD is limited.
See also
Goal
Estimate the burden of TRD in a large cohort of the entire population in an area with universal health care by including data from both types of health care (psychiatric and non-psychiatric) and further develop a prognostic model for clinical use.
Design, setting and participants
This cohort study, a population-based observational study, evaluated data from the Stockholm MDD cohort for episodes of major depressive disorder (MDD) between 2010 and 2017 who met predefined criteria for TRD (≥3 consecutive antidepressant treatments ). Data analysis was performed from August 2020 to May 2022.
Main results and measures
Outcomes were psychiatric and non-psychiatric comorbid conditions, antidepressant treatments, health care resource utilization, lost work days, all-cause mortality and intentional self-harm, and, in the prognostic model, TRD.
Results
A total of 158,169 unipolar MDD episodes (in 145,577 patients) were identified between January 1, 2012, and December 31, 2017 (64.7% female; median [IQR] age, 42 years [30-56]). Of these, 12,793 episodes (11%) met criteria for TRD. The median (IQR) time from MDD episode onset to TRD was 552 days (294-932). Selective serotonin reuptake inhibitor was the most common class of antidepressant treatment across all treatment steps, with 5,907 patients (46.2%) receiving psychotherapy at some point before the start of the third pharmacologic antidepressant treatment. Compared with matched non-TRD episodes, TRD episodes had more hospital days (mean, 3.9 days; 95% CI, 3.6-4.1, vs. 1.3 days; 95% CI, 1.2-1.4) and more work days lost (mean, 132.3 days; 95% CI, 129.5-135.1, vs. 58.7 days; 95% CI, 56.8 -60.6) 12 months after the index date. Anxiety, stress, sleep disorder, and substance use disorder were the most common comorbid conditions in TRD episodes. Intentional self-harm was more than 4 times more common in TRD episodes. The all-cause mortality rate for MDD patients with TRD episodes was 10.7/1,000 person-years at risk, compared with 8.7/1,000 person-years at risk for MDD patients without TRD episodes. (hazard ratio, 1.23; 95% CI, 1.07-1.41). The median time from the start of the first antidepressant treatment to the start of the second, and from the start of the second antidepressant treatment to the start of the third, was 165 and 197 days, respectively. MDD severity, defined using the self-rated Montgomery-Åsberg Depression Rating Scale (MADRS-S) at the time of MDD diagnosis, was found to be the most important prognostic factor for TRD (C-index = 0 .69).
Conclusions and Relevance
In this cohort study, TRD was a common variant of MDD when patients from both types of healthcare were included, which is associated with a high burden of disease for both patients and society. The median time between initiation of new antidepressant treatments was longer than recommended in current treatment guidelines, suggesting room for more structured and timely depression care.
