Prediction of longer-term outcome of treatment-resistantdepression in tertiary care

• Published in: British journal of psychiatry 2012-11, Vol.201 (5), p.369-375
• Main Authors: Abebaw, Fekadu, Rane, Lena J, Wooderson, Sarah C, Markopoulou Kalypso, Poon, Lucia, Cleare, Anthony J
• Format: Article
• Language: eng ; jpn
• Subjects: Academic achievement; Antidepressants; Bipolar disorder; Duloxetine; Electroconvulsive therapy; Emotional disorders; Inpatient care; Medical diagnosis; Mental depression; Mental disorders; Patients; Psychiatry; Relapse; Remission; Remission (Medicine)
• ISSN: 0007-1250; 1472-1465
• DOI: 10.1192/bjp.bp.111.102665

BackgroundSystematic studies on the outcome of treatment-resistant depression arescarce.AimsTo describe the longer-term outcome and predictors of outcome intreatment-resistant depression.MethodOut of 150 patients approached, 118 participants with confirmedtreatment-resistant depression (unipolar, n= 7; bipolar,n=27; secondary, n=14) treated in aspecialist in-patient centre were followed-up for between 8 and 84 months(mean=39, s.d.=22).ResultsThe majority of participants attained full remission (60.2%), most ofwhom (48.3% of total sample) showed sustained recovery (full remissionfor at least 6 months). A substantial minority had persistentsubsyndromal depression (19.5%) or persistent depressive episode (20.3%).Diagnosis of bipolar treatment-resistant depression and poorer socialsupport were associated with early relapse, whereas strong socialsupport, higher educational status and milder level of treatmentresistance measured with the Maudsley Staging Method were associated withachieving quicker remission. Exploratory analysis of treatment foundpositive associations between treatment with a monoamine oxidaseinhibitor (MAOl) in unipolar treatment-resistant depression and attainingremission at discharge and at final follow-up, and duloxetine usepredicted attainment of remission at final follow-up.ConclusionsAlthough many patients with treatment-resistant depression experiencepersistent symptomatology even after intensive, specialist treatment,most can achieve remission. The choice of treatment and presence of goodsocial support may affect remission rates, whereas those with low socialsupport and a bipolar diathesis should be considered at higher risk ofearly relapse. We suggest that future work to improve the long-termoutcome in this disabling form of depression might focus on socialinterventions to improve support, and the role of neglectedpharmacological interventions such as MAOIs.