• Treatment Resistant Depression (TRD)

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 ciclicitymarked clinical history is associated with more favourable outcome.