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Tesi etd-12112014-160220


Thesis type
Tesi di dottorato di ricerca
Author
LOMBARDI, VALENTINA
URN
etd-12112014-160220
Title
COURSE AND OUTCOME OF TREATMENT RESISTANT DEPRESSION: A ONE-YEAR NATURALISTIC FOLLOW-UP
Settore scientifico disciplinare
MED/25
Corso di studi
NEUROSCIENZE E SCIENZE ENDOCRINOMETABOLICHE
Commissione
tutor Prof. Mauri, Mauro
Parole chiave
  • treatment resistant depression
  • psychiatry
Data inizio appello
15/12/2014;
Consultabilità
completa
Riassunto analitico
Most recent epidemiological studies point out that depression is one of the most common diseases <br>among general population and it is recognized as a major public health problem. The primary goal <br>of depression treatment consists of the complete resolution of symptoms and thus in the total <br>healing. Clinical experience and literature data indicate that, with current treatments, only a small <br>percentage of patients achieves a full symptom remission. The results of the STAR*D, which <br>focused on the effectiveness of treatments, showed that one-third of depressed patients will never <br>reach complete recovery even after multiple drug trials<br>5.<br>. From these data emerges that treatment <br>resistance is quite common among patients with Major Depressive Disorders and accounts for an <br>important part of human suffering and social burden caused by depression<br>6-7<br>.<br>In the present study we examined a sample of depressed inpatients during a one-year naturalistic <br>follow-up. The aims of the study were: 1) to investigate the demographic and clinical characteristics <br>associated with Treatment Resistant Depression (TRD); 2) to evaluate the prospective course and <br>outcome of illness over a one-year naturalistic follow-up; 3) to compare the clinical and <br>demographic variables of treatment-resistant patients with a group of patients matched by sex and <br>diagnosis, who adequately responded to the drug treatment<br>A consecutive series of subjects, aged 18-70 years, hospitalized in our centre, with a Major Unipolar <br>or Bipolar Depression diagnosis recruited from January 2008 to January 2009 were included in the <br>analysis (TRd: Treatment resistant depressives) . Patients with a primary diagnosis of Unipolar <br>MDD or BPD; stage I of Thase &amp; Rush criteria for resistance to treatment and a baseline <br>Montgomery-Asberg Depression Scale (MADRS)<br>149<br>score &gt; 21 were included in the study and <br>were enrolled in the 12 months naturalistic follow up . Afterwards, we screened a sample of 47 <br>outpatients matched by sex with the same inclusion and exclusion criteria, except that of treatment <br>resistance, in fact they began antidepressant treatment not later than two months before with <br>positive response.(Rd: Responder depressives)<br>In our study TRD population is mainly composed by middle aged female, married, with high level <br>of education. TRD patients report a personal history of treatment resistance and personal and <br>familiar history of suicide attempts. A bipolar diathesis may represent an important clinical <br>characteristics of TRD patients, too. Treatment resistance appears mainly related to melancholic <br>episodes, duration of the current episode, number of previous depressive episodes and <br>hospitalizations, and suicide risk. Somatic comorbidity (specifically cardiovascular diseases), Axis I <br>disorder comorbidity, particularly anxiety disorders (Panic Disorder) may be highly frequent in<br>TRD population. During the follow up year the majority of the TRD patients examined (63.8%) <br>have a remission and about 20% of the sample have a recovery.<br>Although TRD is a common clinical occurrence, a greater consensus is required regarding the <br>definition and the operational criteria for staging response and resistance to antidepressant <br>treatments. Predictive factors must be identified to recognize patients who are more likely to <br>respond to antidepressant trials. Pharmacogenomic studies are also needed to assist in identifying <br>biological predictive factors.
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