title: Long-term impact of residual symptoms in treatment-resistant depression.
abstract: OBJECTIVE
  Although commonly encountered, little work has defined the longitudinal course of treatment-resistant depression (TRD) and the influence of residual posttreatment symptoms on longer-term outcome. The aim of our study was to assess the impact of posttreatment clinical states on longer-term outcome.
  
  
  METHODS
  Patients (n = 118) with TRD received specialist inpatient treatment and were followed-up for a median of 3 years. Longitudinal outcome dichotomized into good and poor outcome was used as the primary outcome and functional measures were used as secondary outcomes.
  
  
  RESULTS
  Among 118 treated patients, 40 (34%) entered clinical remission, 36 (31%) entered partial remission, and 42 (37%) remained in episode at discharge. At follow-up, 35% had longitudinally defined poor outcome. Posttreatment clinical status was the main predictor of both poor and good outcome. Nearly 50% of patients achieved postdischarge recovery, and subsequently had longer-term outcome, comparable with patients discharged in remission. Patients who remained in episode posttreatment were more symptomatically and functionally impaired.
  
  
  CONCLUSIONS
  Posttreatment clinical states are a useful guide to clinicians for projecting the longer-term outcome of patients with TRD. The persistence of residual or syndromal symptoms predicts a poorer longer-term outcome, whereas treatment to remission is associated with better outcomes.
authors.affiliation: King's College London, Institute of Psychiatry, Section of Neurobiology of Mood Disorders, England, UK. Abe.Wassie@kcl.ac.uk
authors.forename: Abebaw
authors.initials: A
authors.lastname: Fekadu
authors.forename: Sarah C
authors.initials: SC
authors.lastname: Wooderson
authors.forename: Lena J
authors.initials: LJ
authors.lastname: Rane
authors.forename: Kalypso
authors.initials: K
authors.lastname: Markopoulou
authors.forename: Lucia
authors.initials: L
authors.lastname: Poon
authors.forename: Anthony J
authors.initials: AJ
authors.lastname: Cleare
mesh_terms: D000328:Adult; D061218:Depressive Disorder, Treatment-Resistant / Q000503:physiopathology / Q000628:therapy*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011569:Psychiatric Status Rating Scales; D012008:Recurrence; D012074:Remission Induction; D012720:Severity of Illness Index; D016896:Treatment Outcome