Depression is the leading cause of functional disability the world over. The most common treatments are antidepressants or psychotherapy.
Many sufferers need care for months or years, but a significant share of patients never recover despite two well-implemented treatment attempts. They have what is commonly called treatment-resistant depression.
In a study from Karolinska Institutet, scientists found people with treatment-resistant depression have a 23% higher risk of death than other depressed patients.
They also have twice as much outpatient care and spend three times the number of days in inpatient care.
The findings suggest that it is important to identify patients at risk of developing treatment-resistant depression.
In the study, the team examined the effects of treatment-resistant depression at both an individual and societal level, something that has not been studied to the same extent previously.
In the study, the researchers used data from several sources. More than 145,000 patients with depression in the Stockholm region were included in the study.
They identified 158,000 depressive episodes in these patients between 2012 and 2017, of which in excess of 12,000 were of a treatment-resistant nature.
The team found that the treatment-resistant group used outpatient resources twice as much, had twice the amount of sick leave, spent three times the number of days in the hospital and had a 23% higher mortality rate than patients with treatment-responsive depression.
They also found increased 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 discovered that the risk of developing treatment-resistant depression could be predicted already at the first depression diagnosis. By far the most important prognostic factor was the self-rated severity of depression.
It took an average of one and a half years for the patients with treatment-resistant depression to undergo the two treatment attempts, which is several months longer than is recommended for assessing the efficacy of a treatment for depression.
The team says that a more frequent replacement of ineffective treatments would probably be of great help for this patient group.
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The study was conducted by Johan Lundberg et al and published in JAMA Psychiatry.
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