Abstract
Treatment-resistant depression (TRD) is associated with a poor quality of life and high economic burden. This observational retrospective epidemiological study aimed to estimate the proportion of patients with TRD within a cohort of patients with major depressive disorder (MDD) in Hungary and examine the mortality and comorbidities of patients with and without TRD. This study included patients with MDD who experienced onset of a new depressive episode between 01 January 2009 and 31 August 2015, using data from a nationwide, longitudinal database. Overall, 99,531 patients were included in the MDD cohort, of which 8,268 (8.3%) also met the criteria for TRD. The overall survival of non-TRD patients was longer than in TRD patients; the risk of mortality for TRD patients was significantly higher than of non-TRD patients (HR [CI] 1.381 [1.212-1.571]; p<0.001). Patients with TRD had a significantly higher probability of having "Neurotic, stress-related and somatoform disordersˮ, autoimmune conditions, cardio- or cerebrovascular diseases, thyroid gland diseases and self-harming behaviour not resulting in death than non-TRD patients (for all comparisons, p values were less than 0.005). To our best knowledge, this is the first study to assess the frequency of TRD in Hungary. In a cohort of Hungarian MDD patients, we have found that the proportion of TRD (~8.3%) is comparable to those reported in previous studies with similar methodology from other countries. The majority of our other main findings (e.g. more frequent self-harming behaviour, increased risk of "Neurotic, stress-related and somatoform disordersˮ and higher overall mortality in TRD subjects) are also in line with previous results from other countries. Taking the substantial proportion of patients with TRD into consideration, a more comprehensive and targeted treatment strategy would be required for these individuals.
Highlights
Major depressive disorder (MDD) is one of the most frequently occurring mental health disorders, with lifetime and 1-year prevalence of approximately 11–18% and 4–7%, respectively [1,2,3,4,5,6]
99,531 patients were included in the MDD cohort, of which 8,268 (8.3%) met the criteria for Treatment-resistant depression (TRD)
Patients with TRD had a significantly higher probability of having “Neurotic, stress-related and somatoform disorders, autoimmune conditions, cardio- or cerebrovascular diseases, thyroid gland diseases and selfharming behaviour not resulting in death than non-TRD patients
Summary
Major depressive disorder (MDD) is one of the most frequently occurring mental health disorders, with lifetime and 1-year prevalence of approximately 11–18% and 4–7%, respectively [1,2,3,4,5,6]. Consistent with results from other countries, a Hungarian study conducted in the mid1990s found that the lifetime and 1-year prevalence of MDD was 15.1% and 7.1%, respectively [7]. Pharmacotherapy-resistant depression (denoted as TRD in the following) is a term used to describe a subpopulation of MDD with a suboptimal response to an adequate dose and duration of antidepressants (ADs); there is not yet a standardised definition for TRD and existing definitions have key differences. The European Medicines Agency (EMA) defines TRD as a lack of clinically meaningful improvement despite the use of adequate doses of at least two AD agents belonging to the group(s) of commonly used first-line treatments prescribed for an adequate duration with adequate affirmation of treatment adherence [16]
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