It is true that patients with treatment-resistant depression (TRD) have a higher risk of early death compared to those with depression that responds to treatment. This is due to several factors such as poor physical health, increased rates of substance abuse and suicide, and a lack of access to adequate healthcare. It is important for people with TRD to seek continued medical treatment and support to improve their overall health and well-being.
Treatment-resistant depression patients have a 23% higher risk of death than other depressed patients. They also receive twice as much outpatient care and spend three times as many days in the hospital. These are the findings of a new study published in JAMA Psychiatry by Karolinska Institutet and other researchers, who conclude that it is critical to identify patients who are at risk of developing treatment-resistant depression.
Depression is the most common cause of functional disability worldwide. Antidepressants and psychotherapy are the most commonly used treatments. Many patients require care for months or years, but despite two well-implemented treatment attempts, a significant proportion of patients never recover. They suffer from what is known as treatment-resistant depression.
Researchers at Karolinska Institutet and the Centre for Psychiatric Research have now examined the effects of treatment-resistant depression in Region Stockholm at both an individual and societal level, something that has not been studied to the same extent previously.
We discovered that patients with treatment-resistant depression used twice as many outpatient resources, took twice as much sick leave, spent three times as many days in the hospital, and had a 23% higher mortality rate than patients with treatment-responsive depression.
Johan Lundberg
Examined patients around Stockholm
The researchers used data from several sources in the population-based observation study, including Region Stockholm’s administrative healthcare database and the Swedish Social Insurance Agency. The study included over 145,000 depressed patients from the Stockholm area. The researchers were able to draw a number of conclusions about what characterizes patients with treatment-resistant depression after identifying 158,000 depressive episodes in these patients between 2012 and 2017, of which over 12,000 were of a treatment-resistant nature.
“We discovered that patients with treatment-resistant depression used twice as many outpatient resources, took twice as much sick leave, spent three times as many days in the hospital, and had a 23% higher mortality rate than patients with treatment-responsive depression,” says Johan Lundberg, adjunct professor of psychiatry at the Department of Clinical Neuroscience and head of the mood disorder section at the Northern Stockholm Psychiatry Clinic.
They also discovered increased comorbidity with other psychiatric conditions in the group with treatment-resistant depression, such as anxiety syndrome, insomnia, substance abuse syndrome, and self-harm.
Severity of depression an important predictor
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.
“We would benefit from identifying patients at risk of developing treatment-resistant depression since it causes a great deal of personal suffering and is a burden for the whole of society,” says Professor Johan Lundberg.
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. Professor Lundberg says that a more frequent replacement of ineffective treatments would probably be of great help for this patient group.
“We’re talking about a patient population with high healthcare utilization that could be identified earlier than currently by increasing the use of symptom severity rating scales. According to the study’s findings, their care and treatment could be improved if their doctor replaced ineffective treatments more quickly and used treatments recommended for treatment-resistant depression, such as lithium, more frequently than was the case in the study material” Professor Lundberg explains.
Region Stockholm initiated and funded the study, which was carried out in collaboration with the pharmaceutical company Janssen-Cilag.
