Most recent epidemiological studies point out that depression is one of the most common diseases
among general population and it is recognized as a major public health problem. The primary goal
of depression treatment consists of the complete resolution of symptoms and thus in the total
healing. Clinical experience and literature data indicate that, with current treatments, only a small
percentage of patients achieves a full symptom remission. The results of the STAR*D, which
focused on the effectiveness of treatments, showed that one-third of depressed patients will never
reach complete recovery even after multiple drug trials
5.
. From these data emerges that treatment
resistance is quite common among patients with Major Depressive Disorders and accounts for an
important part of human suffering and social burden caused by depression
6-7
.
In the present study we examined a sample of depressed inpatients during a one-year naturalistic
follow-up. The aims of the study were: 1) to investigate the demographic and clinical characteristics
associated with Treatment Resistant Depression (TRD); 2) to evaluate the prospective course and
outcome of illness over a one-year naturalistic follow-up; 3) to compare the clinical and
demographic variables of treatment-resistant patients with a group of patients matched by sex and
diagnosis, who adequately responded to the drug treatment
A consecutive series of subjects, aged 18-70 years, hospitalized in our centre, with a Major Unipolar
or Bipolar Depression diagnosis recruited from January 2008 to January 2009 were included in the
analysis (TRd: Treatment resistant depressives) . Patients with a primary diagnosis of Unipolar
MDD or BPD; stage I of Thase & Rush criteria for resistance to treatment and a baseline
Montgomery-Asberg Depression Scale (MADRS)
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score > 21 were included in the study and
were enrolled in the 12 months naturalistic follow up . Afterwards, we screened a sample of 47
outpatients matched by sex with the same inclusion and exclusion criteria, except that of treatment
resistance, in fact they began antidepressant treatment not later than two months before with
positive response.(Rd: Responder depressives)
In our study TRD population is mainly composed by middle aged female, married, with high level
of education. TRD patients report a personal history of treatment resistance and personal and
familiar history of suicide attempts. A bipolar diathesis may represent an important clinical
characteristics of TRD patients, too. Treatment resistance appears mainly related to melancholic
episodes, duration of the current episode, number of previous depressive episodes and
hospitalizations, and suicide risk. Somatic comorbidity (specifically cardiovascular diseases), Axis I
disorder comorbidity, particularly anxiety disorders (Panic Disorder) may be highly frequent in
TRD population. During the follow up year the majority of the TRD patients examined (63.8%)
have a remission and about 20% of the sample have a recovery.
Although TRD is a common clinical occurrence, a greater consensus is required regarding the
definition and the operational criteria for staging response and resistance to antidepressant
treatments. Predictive factors must be identified to recognize patients who are more likely to
respond to antidepressant trials. Pharmacogenomic studies are also needed to assist in identifying
biological predictive factors.