Patients with treatment resistant depression are at a higher risk of death 

Patients with treatment resistant depression are at a higher risk of death 
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People with treatment resistant depression have a 23% higher risk of fatality than other depressed patients. 

Patients with treatment resistant depression also need twice the amount of outpatient care and spend three times as long in inpatient care, according to researchers from Karolinska Institutet 

The findings have been published in JAMA Psychiatry. 

Patients with treatment resistant depression will often not recover

Depression is the leading cause of functional disability in the world. Depression is usually treated with antidepressants or psychotherapy and patients often need care for months or years. However, a significant proportion of patients never recover despite well-implemented treatment attempts. These cases are known as treatment resistant depression.     

The researchers assessed the effects of resistant depression in Stockholm at both an individual and societal level. This is the first time resistant depression has been examined on this scale.  

The researchers used data from several sources, including Region Stockholm’s administrative healthcare database and the Swedish Social Insurance Agency, to complete a population-based observational study. Over 145,000 patients with depression in the Stockholm region participated in the study.   

The team identified 158,000 depressive episodes in these participants between 2012 and 2017. Over 12,000 of these were of a treatment-resistant nature. The researchers reached conclusions on how to characterises patients with resistant depression.     

“We found that the treatment-resistant group used outpatient resources twice as much, had twice the amount of sick leave, spent three times the number of days in hospital and had a 23%higher mortality rate than patients with treatment-responsive depression,” said Johan Lundberg, adjunct professor of psychiatry at the Department of Clinical Neuroscience and head of the mood disorder section at the Northern Stockholm Psychiatry Clinic.    

Patients also suffered from other psychiatric conditions

The researchers also noticed increased comorbidity with other psychiatric conditions, such as anxiety syndrome, insomnia, substance abuse syndrome and self-harm in participants with treatment resistant depression.   

The researchers concluded that the risk of developing resistant depression could be predicted already as early as the first depression diagnosis. Self-rated severity of depression was the most important prognostic factor, according to the researchers.  

“We would benefit from identifying patients at risk of developing resistant depression, since it causes a great deal of personal suffering and is a burden for the whole of society,” said Professor Lundberg. 

On average, it took one and a half years for patients with resistant depression to complete the two treatment attempts. This is of one and a half years for patients with resistant depression to undergo the two treatment attempts. This is several months longer than is recommended for assessing depression severity.  

“We’re talking about a patient group with a substantial health care consumption that might be identified earlier than today by increasing the use of symptom severity rating scales. Going by the results of the study, their care and treatment could be improved if their physician replaced ineffective treatments more rapidly and more often used treatments recommended for resistant depression, such as lithium, than was the case in the study material,” concluded Professor Lundberg.     


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