title: Characteristics and differences in treatment outcome of inpatients with chronic vs. episodic major depressive disorders.
abstract: BACKGROUND
  Approximately 20-30% of patients with Major depressive disorder (MDD) develop a chronic course of their disease. Chronic depression is associated with increased health care utilisation, hospitalisation and a higher disease burden. We identified clinical correlates and differences in treatment response of chronic MDD (cMDD) patients compared with non-chronic episodic depression in a huge sample of depressive inpatients.
  
  
  METHODS
  Data were collected from 412 inpatients who had been diagnosed with a major depressive episode (MDE; according to ICD-10) and scored 15 or higher on the 21-item Hamilton Depression Rating Scale (HRSD-21). All subjects were participants in the German Algorithm Project, phase 3 (GAP3). Patients who were diagnosed with a MDE within the last two years or longer (herein referred to as CD) were compared with non-chronic depressive patients (herein referred to as non-CD). CD and non-CD patients were assessed for the following: psychosocial characteristics, symptom reduction from hospital admission to discharge, symptom severity at discharge, remission and response rates, and pharmacological treatment during inpatient treatment. The primary outcome measure was the HRSD-21.
  
  
  RESULTS
  13.6% (n=56) of patients met the criteria for chronic depression. Compared with non-CD patients, patients with CD showed increased axis I comorbidities (74% vs. 52%, χ(2) (1)=7.31, p=.02), a higher level of depressive symptoms at baseline and discharge, increased duration of inpatient treatment (64.8 vs. 53.3 days; t=2.86, p=.03) and lower response (HRSD: 60.0% vs. 72.0%; χ(2) (1)=3.61, p<.04; BDI: 40.5% vs. 54.2%; χ(2) (1)=3.56, p=.04) and remission rates (BDI 17.9.% vs. 29.7%; χ(2) (1)=3.42, p=.05. However, both groups achieved a comparable symptom reduction during inpatient treatment. The prescribed pharmacological strategy had no significant influence on treatment outcome in patients with CD.
  
  
  CONCLUSIONS
  Inpatients with CD show higher symptom severity, lower response and remission rates and a longer duration of inpatient treatment, although they achieve comparable symptom reduction during treatment. These findings support the need to recognise CD and its defining characteristics as a distinct subclass of depression.
authors.affiliation: Charité - Universitätsmedizin Berlin, Department of Psychiatry and Psychotherapy, Campus Charité Mitte, Berlin, Germany. Electronic address: stephan.koehler@charite.de.
authors.forename: Stephan
authors.initials: S
authors.lastname: Köhler
authors.affiliation: Charité - Universitätsmedizin Berlin, Department of Psychiatry and Psychotherapy, Campus Charité Mitte, Berlin, Germany.
authors.forename: Katja
authors.initials: K
authors.lastname: Wiethoff
authors.affiliation: Charité - Universitätsmedizin Berlin, Department of Psychiatry and Psychotherapy, Campus Charité Mitte, Berlin, Germany.
authors.forename: Roland
authors.initials: R
authors.lastname: Ricken
authors.affiliation: Charité - Universitätsmedizin Berlin, Department of Psychiatry and Psychotherapy, Campus Charité Mitte, Berlin, Germany.
authors.forename: Thomas
authors.initials: T
authors.lastname: Stamm
authors.affiliation: Department of Psychiatry and Psychotherapy, University Hospital Regensburg, Germany.
authors.forename: Thomas C
authors.initials: TC
authors.lastname: Baghai
authors.affiliation: Eastlondon NHS Foundation Trust, City and Hackney Centre for Mental Health, Donald Winnicott Centre, London, UK.
authors.forename: Robert
authors.initials: R
authors.lastname: Fisher
authors.affiliation: Department of Psychiatry and Psychotherapy, Ludwig-Maximilians-Universität, Munich, Germany; Lech-Mangfall-Klinik, Garmisch-Patenkirchen, Germany.
authors.forename: Florian
authors.initials: F
authors.lastname: Seemüller
authors.affiliation: Bezirkskrankenhaus Kempten, Germany.
authors.forename: Peter
authors.initials: P
authors.lastname: Brieger
authors.affiliation: Department of Psychiatry and Psychotherapy, Heinrich-Heine-Universität, Düsseldorf, Germany.
authors.forename: Joachim
authors.initials: J
authors.lastname: Cordes
authors.affiliation: Department of Psychiatry and Psychotherapy, Heinrich-Heine-Universität, Düsseldorf, Germany.
authors.forename: Jaroslav
authors.initials: J
authors.lastname: Malevani
authors.affiliation: Inn-Salzach-Klinikum, Wasserburg am Inn, Germany.
authors.forename: Gerd
authors.initials: G
authors.lastname: Laux
authors.affiliation: Department of Psychiatry and Psychotherapy, St. Joseph-Krankenhaus, Berlin, Germany.
authors.forename: Iris
authors.initials: I
authors.lastname: Hauth
authors.affiliation: Department of Psychiatry and Psychotherapy, Ludwig-Maximilians-Universität, Munich, Germany.
authors.forename: Hans-Jürgen
authors.initials: HJ
authors.lastname: Möller
authors.affiliation: Department of Psychiatry and Psychotherapy, Auguste-Viktoria-Krankenhaus, Berlin, Germany.
authors.forename: Joachim
authors.initials: J
authors.lastname: Zeiler
authors.affiliation: Charité - Universitätsmedizin Berlin, Department of Psychiatry and Psychotherapy, Campus Charité Mitte, Berlin, Germany.
authors.forename: Andreas
authors.initials: A
authors.lastname: Heinz
authors.affiliation: Department of Psychiatry and Psychotherapy, Universitätsklinikum Carl Gustav Carus, Dresden, Germany.
authors.forename: Michael
authors.initials: M
authors.lastname: Bauer
authors.affiliation: Charité - Universitätsmedizin Berlin, Department of Psychiatry and Psychotherapy, Campus Charité Mitte, Berlin, Germany; Fliedner Hospital Berlin, Germany.
authors.forename: Mazda
authors.initials: M
authors.lastname: Adli
mesh_terms: D000328:Adult; D000928:Antidepressive Agents / Q000627:therapeutic use; D016022:Case-Control Studies; D002908:Chronic Disease; D003865:Major Depressive Disorder / Q000145:classification* / Q000188:drug therapy* / Q000523:psychology; D005260:Female; D006801:Humans; D007297:Inpatients / Q000523:psychology*; D008297:Male; D008875:Middle Aged; D012008:Recurrence; D016896:Treatment Outcome
chemical_list: D000928:Antidepressive Agents
keywords: Anti-depressive treatment; Chronic depression; German algorithm project; Response