Digital archive of theses discussed at the University of Pisa


Thesis etd-07042016-193628

Thesis type
Tesi di specializzazione (5 anni)
Thesis title
Long-term outcome of Treatment-Resistant Depression
Course of study
relatore Prof. Perugi, Giulio
  • ciclicity
  • relapse
  • remission
Graduation session start date
According to most recent epidemiological records, depression is to be considered one of the most common diagnosis in psychiatry. Clinical experience and available data clearly indicate that the majority of individuals with MD, receiving guideline-concordant and measurement-based care, do not achieve a fully and sustained remission with current antidepressants. To characterize patients with depressive syndrome, who are unable to achieve a significant therapeutic response after multiple antidepressant trials, it has been introduced in the 1970s the concept of Treatment Resistant Depression (TRD).
In the present study we examined a sample of 50 TRD (both unipolar and bipolar) inpatients during a one-year naturalistic follow-up. The aims of the study were: to investigate the socio-demographic and clinical characteristics associated with TRD; to prospectively evaluate the course and the outcome of TRD over a one-year naturalistic follow-up; to compare clinical and therapeutic characteristics of sub-groups of patients, distinguished on the basis of the outcome: Remitters (patients with remission during 1-year follow up) versus Non-remitters (patients without remission and patients with relapse during 1-year follow up) Relapsed (patients with relapse after remission during the follow-up period) versus Non-relapsed (patients without relapse).
The 40% of our sample achieved the remission during the follow up. The comparison between remitters and non-remitters reported that remitters had higher prevalence of female gender and higher number of previous (ipo)manic episodes, while non-remitters showed higher rate of use of SSRIs, during the follow up. The 15% of remitters developed the relapse of depressive episode before the end of follow up. This subgroup of relapsed patients was characterized by higher prevalence of atypical and melancholic depression and greater rate of comorbid cardiovascular disease.
Overall the findings of the study were consistent with literature evidence on sociodemographic and clinical determinants of TRD. The considerable rate of remission of our patients may support the long term benefits of intensive, individualized, inpatient and multidisciplinary treatments for this severe and treatment refractory forms of depression. Data from follow up may indicate that a ciclicity-marked clinical history is associated with more favourable outcome.