Prospective, long-term, multicenter study of the naturalistic outcomes of patients with treatment-resistant depression.
BACKGROUND
Treatment-resistant depression (TRD) is a long-term, disabling illness. We report on the characteristics and outcomes of a large cohort of patients with a level of treatment resistance that is very substantial and who were treated for 2 years with standard care.


METHODS
This 2-year prospective, multicenter, observational study (patients enrolled from January 2001 through July 2004) tracked the outcomes of 124 patients with treatment-resistant, nonpsychotic major depressive disorder (N = 109) or bipolar depressed phase disorder (N = 15) who received treatment as usual (TAU) (i.e., any therapeutic regimen agreed to by patients and psychiatrists, including medications, electroconvulsive therapy [ECT], and psychotherapy). Treatments could be adjusted, started, and stopped as necessary. The primary outcome, treatment response, was defined a priori as > or = 50% improvement from baseline as measured by the 30-item Inventory of Depressive Symptomatology-Self-Report (IDS-SR-30). Remission was defined as an IDS-SR-30 score of < or = 14. The Medical Outcomes Study (MOS) 36-item Short Form Health Survey (SF-36) was used to monitor quality-of-life changes.


RESULTS
The 12- and 24-month IDS-SR-30 response rates were 11.6% (13/112) and 18.4% (19/103), respectively. Of the 13 responders at 12 months, only 5 were responders at 24 months. The 12- and 24-month IDS-SR-30 remission rates were 3.6% (4/112) and 7.8% (8/103), respectively. Only 1 of the 4 12-month remitters was also a remitter at 24 months. The SF-36 indicated globally poor quality of life in this sample.


CONCLUSIONS
Despite the wide range of treatment options available for depression, the response rates, remission rates, and quality-of-life results in this study show that most patients with a substantial degree of treatment resistance continue to have significant symptomatology and functional disability when receiving TAU.
Dunner
David L
DL
Center for Anxiety and Depression, Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle 98105, USA. ddunner@u.washington.edu
Rush
A John
AJ
Russell
James M
JM
Burke
Michael
M
Woodard
Stacy
S
Wingard
Peggy
P
Allen
John
J
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000928:Antidepressive Agents / Q000627:therapeutic use; D001714:Bipolar Disorder / Q000175:diagnosis / Q000523:psychology / Q000628:therapy*; D015331:Cohort Studies; D003866:Depressive Disorder / Q000175:diagnosis / Q000523:psychology / Q000628:therapy; D003865:Major Depressive Disorder / Q000175:diagnosis / Q000523:psychology / Q000628:therapy*; D004351:Drug Resistance; D004565:Electroconvulsive Therapy; D006304:Health Status; D006801:Humans; D008137:Longitudinal Studies; D008875:Middle Aged; D010555:Personality Inventory; D011446:Prospective Studies; D011569:Psychiatric Status Rating Scales; D011613:Psychotherapy; D011619:Psychotropic Drugs / Q000627:therapeutic use; D011788:Quality of Life; D012008:Recurrence; D011795:Surveys and Questionnaires; D016896:Treatment Outcome
D000928:Antidepressive Agents; D011619:Psychotropic Drugs