@article{846eab43638e4f0ab283f0b066584445,
title = "Characterising the severity of treatment resistance in unipolar and bipolar depression",
abstract = "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. ",
keywords = "Depressive disorders, in-patient treatment, individual psychotherapy, out-patient treatment, rating scales",
author = "Taylor, {Rachael W.} and Rebecca Strawbridge and Young, {Allan H.} and Roland Zahn and Cleare, {Anthony J.}",
note = "Funding Information: In the past 3 years: A.H.Y. has received honoraria for speaking from Astra Zeneca, Lundbeck, Eli Lilly, Sunovion; honoraria for consulting from Allergan, Livanova and Lundbeck, Sunovion, Janssen; and research grant support from Janssen. A.J.C. has received honoraria for educational activities from Lundbeck and Janssen; honoraria for consulting from Allergan and Janssen; sponsorship for conference attendance from Janssen; and research grant support from Protexin Probiotics International Ltd. R.S. has received an honorarium for speaking from Lundbeck. R.Z. provides private psychiatric services at The London Depression Institute, is an honorary principal investigator at D'OR Institute for Research & Education, Rio de Janeiro, a not-for-profit organisation, on the Advisory Board for Scients – a US not-for-profit organisation, has consulted for Fortress Biotech, is a co-investigator on a Livanova-funded study, has received speaker honoraria for medical symposia and educational activities from Lundbeck and Janssen; collaborates with Janssen, EMIS PLC and Alloc Modulo Ltd. A.H.Y. and R.Z. are members of the BJPsych Open editorial board, but did not take part in the review or decision-making process for this paper. Funding Information: The LQD study is funded by a grant from the National Institute for Health Research (NIHR) Health Technology Assessment (HTA) programme (reference 14/222/02). This research was also part-funded by the Wellcome Trust King's Clinical Research Facility, the NIHR Cognitive Health CRF, the NIHR Biomedical Research Centre at the South London and Maudsley NHS Foundation Trust and King's College London, and the NIHR Oxford Health BRC. The views expressed are those of the author (s) and not necessarily those of the NHS, the NIHR or the Department of Health and Social Care. Acknowledgements Publisher Copyright: {\textcopyright} 2021 The Author(s). Published by Cambridge University Press on behalf of the Royal College of Psychiatrists.",
year = "2021",
month = nov,
day = "13",
doi = "10.1192/bjo.2021.1004",
language = "English",
volume = "7",
journal = "BJPsych Open",
issn = "2056-4724",
publisher = "Cambridge University Press",
number = "6",
}
