Characterising the severity of treatment resistance in unipolar and bipolar depression
Background Treatment-resistant depression (TRD) is classically defined according to the number of suboptimal antidepressant responses experienced, but multidimensional assessments of TRD are emerging and may confer some advantages. Patient characteristics have been identified as risk factors for TRD...
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| Format: | Article |
| Language: | English |
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Cambridge University Press
2021-11-01
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| Series: | BJPsych Open |
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| Online Access: | https://www.cambridge.org/core/product/identifier/S2056472421010048/type/journal_article |
| _version_ | 1827995644296429568 |
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| author | Rachael W. Taylor Rebecca Strawbridge Allan H. Young Roland Zahn Anthony J. Cleare |
| author_facet | Rachael W. Taylor Rebecca Strawbridge Allan H. Young Roland Zahn Anthony J. Cleare |
| author_sort | Rachael W. Taylor |
| collection | DOAJ |
| description | Background
Treatment-resistant depression (TRD) is classically defined according to the number of suboptimal antidepressant responses experienced, but multidimensional assessments of TRD are emerging and may confer some advantages. Patient characteristics have been identified as risk factors for TRD but may also be associated with TRD severity. The identification of individuals at risk of severe TRD would support appropriate prioritisation of intensive and specialist treatments.
Aims
To determine whether TRD risk factors are associated with TRD severity when assessed multidimensionally using the Maudsley Staging Method (MSM), and univariately as the number of antidepressant non-responses, across three cohorts of individuals with depression.
Method
Three cohorts of individuals without significant TRD, with established TRD and with severe TRD, were assessed (n = 528). Preselected characteristics were included in linear regressions to determine their association with each outcome.
Results
Participants with more severe TRD according to the MSM had a lower age at onset, fewer depressive episodes and more physical comorbidities. These associations were not consistent across cohorts. The number of episodes was associated with the number of antidepressant treatment failures, but the direction of association varied across the cohorts studied.
Conclusions
Several risk factors for TRD were associated with the severity of resistance according to the MSM. Fewer were associated with the raw number of inadequate antidepressant responses. Multidimensional definitions may be more useful for identifying patients at risk of severe TRD. The inconsistency of associations across cohorts has potential implications for the characterisation of TRD.
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| first_indexed | 2024-04-10T04:59:34Z |
| format | Article |
| id | doaj.art-d29d0ac040164ca8b0d51d80a0d6c418 |
| institution | Directory Open Access Journal |
| issn | 2056-4724 |
| language | English |
| last_indexed | 2024-04-10T04:59:34Z |
| publishDate | 2021-11-01 |
| publisher | Cambridge University Press |
| record_format | Article |
| series | BJPsych Open |
| spelling | doaj.art-d29d0ac040164ca8b0d51d80a0d6c4182023-03-09T12:29:17ZengCambridge University PressBJPsych Open2056-47242021-11-01710.1192/bjo.2021.1004Characterising the severity of treatment resistance in unipolar and bipolar depressionRachael W. Taylor0https://orcid.org/0000-0001-6471-537XRebecca Strawbridge1https://orcid.org/0000-0002-2984-1124Allan H. Young2https://orcid.org/0000-0003-2291-6952Roland Zahn3https://orcid.org/0000-0002-8447-1453Anthony J. Cleare4The Centre for Affective Disorders, Department of Psychological Medicine, Institute of Psychiatry Psychology and Neuroscience, King's College London, UKThe Centre for Affective Disorders, Department of Psychological Medicine, Institute of Psychiatry Psychology and Neuroscience, King's College London, UKThe Centre for Affective Disorders, Department of Psychological Medicine, Institute of Psychiatry Psychology and Neuroscience, King's College London, UK; and South London and Maudsley NHD Foundation Trust, UKThe Centre for Affective Disorders, Department of Psychological Medicine, Institute of Psychiatry Psychology and Neuroscience, King's College London, UK; and South London and Maudsley NHD Foundation Trust, UKThe Centre for Affective Disorders, Department of Psychological Medicine, Institute of Psychiatry Psychology and Neuroscience, King's College London, UK; and South London and Maudsley NHD Foundation Trust, UKBackground Treatment-resistant depression (TRD) is classically defined according to the number of suboptimal antidepressant responses experienced, but multidimensional assessments of TRD are emerging and may confer some advantages. Patient characteristics have been identified as risk factors for TRD but may also be associated with TRD severity. The identification of individuals at risk of severe TRD would support appropriate prioritisation of intensive and specialist treatments. Aims To determine whether TRD risk factors are associated with TRD severity when assessed multidimensionally using the Maudsley Staging Method (MSM), and univariately as the number of antidepressant non-responses, across three cohorts of individuals with depression. Method Three cohorts of individuals without significant TRD, with established TRD and with severe TRD, were assessed (n = 528). Preselected characteristics were included in linear regressions to determine their association with each outcome. Results Participants with more severe TRD according to the MSM had a lower age at onset, fewer depressive episodes and more physical comorbidities. These associations were not consistent across cohorts. The number of episodes was associated with the number of antidepressant treatment failures, but the direction of association varied across the cohorts studied. Conclusions Several risk factors for TRD were associated with the severity of resistance according to the MSM. Fewer were associated with the raw number of inadequate antidepressant responses. Multidimensional definitions may be more useful for identifying patients at risk of severe TRD. The inconsistency of associations across cohorts has potential implications for the characterisation of TRD. https://www.cambridge.org/core/product/identifier/S2056472421010048/type/journal_articleDepressive disordersin-patient treatmentout-patient treatmentrating scalesindividual psychotherapy |
| spellingShingle | Rachael W. Taylor Rebecca Strawbridge Allan H. Young Roland Zahn Anthony J. Cleare Characterising the severity of treatment resistance in unipolar and bipolar depression BJPsych Open Depressive disorders in-patient treatment out-patient treatment rating scales individual psychotherapy |
| title | Characterising the severity of treatment resistance in unipolar and bipolar depression |
| title_full | Characterising the severity of treatment resistance in unipolar and bipolar depression |
| title_fullStr | Characterising the severity of treatment resistance in unipolar and bipolar depression |
| title_full_unstemmed | Characterising the severity of treatment resistance in unipolar and bipolar depression |
| title_short | Characterising the severity of treatment resistance in unipolar and bipolar depression |
| title_sort | characterising the severity of treatment resistance in unipolar and bipolar depression |
| topic | Depressive disorders in-patient treatment out-patient treatment rating scales individual psychotherapy |
| url | https://www.cambridge.org/core/product/identifier/S2056472421010048/type/journal_article |
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