Treatment-Resistant Depression Common and Costly

Treatment-resistant depression episodes tied to more psychiatric comorbid conditions, health care utilization, self-harm, and all-cause mortality

By Lori Solomon HealthDay Reporter

THURSDAY, Dec. 22, 2022 (HealthDay News) — Treatment-resistant depression (TRD) is associated with a heavy individual and societal burden, according to a study published online Dec. 14 in JAMA Psychiatry.

Johan Lundberg, M.D., Ph.D., from the Karolinska Institutet in Stockholm, and colleagues estimated the burden of TRD in a large population covered by universal health care. Analysis included psychiatric and nonpsychiatric data from the Stockholm Major Depressive Disorder Cohort (2010 to 2017; including 158,169 unipolar MDD episodes in 145,577 patients) using the predefined criteria for TRD of three or more consecutive antidepressant treatments.

The researchers found that 11 percent of MDD episodes fulfilled criteria for TRD, with a median time from the start of MDD episode to TRD of 552 days. TRD episodes had more inpatient bed-days (mean, 3.9 versus 1.3 days) and more lost workdays (mean, 132.3 versus 58.7 days) 12 months after the index date, compared with matched non-TRD episodes. Common comorbid conditions in TRD episodes included anxiety, stress, sleep disorder, and substance use disorder. TRD episodes were also associated with four times higher frequency of intentional self-harm. The all-cause mortality rate for patients with MDD and TRD episodes was 10.7 per 1,000 person-years at risk versus 8.7 per 1,000 person-years at risk among patients with MDD without TRD episodes (hazard ratio, 1.23). Severity of MDD at time of diagnosis was the most important prognostic factor for TRD.

“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,” the authors write.

Two authors disclosed financial ties to the pharmaceutical industry.

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