title: Socio-demographic and clinical predictors of treatment resistant depression: A prospective European multicenter study.
abstract: BACKGROUND
  Few studies investigated socio-demographic and clinical predictors of non response and remission in treatment resistant depression (TRD) in the case of failure of more than two adequate antidepressant (AD) trial. The primary aim of this study was to investigate socio-demographic and clinical predictors of TRD defined as the lack of response to at least three adequate AD treatments, two of which prospectively evaluated. As secondary aims, we also investigated predictors of non response and remission to: (1) at least two adequate AD treatment (one of which prospectively assessed); (2) at least one adequate and retrospectively assessed AD treatment.
  
  
  METHODS
  In the context of a European multicenter project, 407 major depressive disorder (MDD) patients who failed to respond to a previous AD treatment were recruited for a 2 stage trial, firstly receiving venlafaxine and then escitalopram. MINI, HRSD, MADRS, UKU, CGI-S and CGI-I were administered.
  
  
  RESULTS
  Ninety eight subjects (27.61%) were considered as resistant to three AD treatments. Clinical predictors were: longer duration and higher severity of the current episode (p=0.004; ES=0.24; p=0.01; RR=1.41, respectively), outpatient status (p=0.04; RR=1.58), higher suicidal risk level (p=0.02; RR=1.49), higher rate of the first/second degree psychiatric antecedents (MDD and others) (p=0.04; RR=1.31, p=0.03; RR=1.32 respectively) and side effects during treatments (p=0.002; RR=2.82). Multivariate analyses underlined the association between TRD and the severity of the current episode (p=0.04). As for secondary outcomes, predicting factors were partially overlapping.
  
  
  CONCLUSIONS
  The limited sample size and specific drugs used limit present findings.
  
  
  CONCLUSIONS
  Subjects with a high degree of resistance to AD treatments show specific features which may guide the clinicians to the choice of more appropriate therapies at baseline.
authors.affiliation: Department of Biomedical and NeuroMotor Sciences, University of Bologna, Viale Carlo Pepoli 5, 40123 Bologna, Italy.
authors.forename: Martina
authors.initials: M
authors.lastname: Balestri
authors.affiliation: INSERM U1061, University of Montpellier, FondaMental Foundation, Montpellier, France.
authors.forename: Raffaella
authors.initials: R
authors.lastname: Calati
authors.affiliation: Laboratoire de Psychologie Médicale, Université Libre de Bruxelles, and Centre Européen de Psychologie Médicale-PsyPluriel, Brussels, Belgium.
authors.forename: Daniel
authors.initials: D
authors.lastname: Souery
authors.affiliation: Medical University of Vienna, Department of Psychiatry and Psychotherapy, Vienna, Austria.
authors.forename: Alexander
authors.initials: A
authors.lastname: Kautzky
authors.affiliation: Medical University of Vienna, Department of Psychiatry and Psychotherapy, Vienna, Austria.
authors.forename: Siegfried
authors.initials: S
authors.lastname: Kasper
authors.affiliation: University of London, Imperial College, London, United Kingdom.
authors.forename: Stuart
authors.initials: S
authors.lastname: Montgomery
authors.affiliation: Chaim Sheba Medical Center, Chaim Sheba Medical Center, Tel-Hashomer, Israel.
authors.forename: Joseph
authors.initials: J
authors.lastname: Zohar
authors.affiliation: Université Libre de Bruxelles, Brussels, Belgium.
authors.forename: Julien
authors.initials: J
authors.lastname: Mendlewicz
authors.affiliation: Department of Biomedical and NeuroMotor Sciences, University of Bologna, Viale Carlo Pepoli 5, 40123 Bologna, Italy. Electronic address: alessandro.serretti@unibo.it.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Serretti
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000928:Antidepressive Agents / Q000627:therapeutic use*; D015283:Citalopram / Q000627:therapeutic use; D003865:Major Depressive Disorder / Q000175:diagnosis / Q000188:drug therapy / Q000209:etiology; D061218:Depressive Disorder, Treatment-Resistant / Q000175:diagnosis / Q000188:drug therapy / Q000209:etiology*; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012189:Retrospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D012959:Socioeconomic Factors; D000069470:Venlafaxine Hydrochloride / Q000627:therapeutic use; D055815:Young Adult
chemical_list: D000928:Antidepressive Agents; D015283:Citalopram; D000069470:Venlafaxine Hydrochloride
keywords: Antidepressant; Depression; Predictors; Remission; Response