Comparison of Staging Methods for Treatment-Resistant Depression: Chart Review

Abstract

IntroductionTreatment-resistant depression (TRD) lacks a universally consistent definition due to varied interpretations despite attempts to define it based on inadequate response or remission despite sufficient antidepressant treatment. There’s a crucial demand for a uniform definition and staging to streamline its effective management amid diverse treatment options and the complex nature of resistance. Five methods have emerged to define and classify treatment resistance reliably.Objectives The aim of this study is to compare the five staging methods (Thase&Rush SM (T&R), European Staging Method (ESM), Maudsley Staging Method (MSM), Massachusetts General Hospital Staging Method (MHG-s), Conway Staging Method(Conway)) in assessing treatment resistance within a single sample.Methods Retrospective analysis involved medical records of inpatient psychiatry clinic admissions at Hacettepe University between October 2012 and October 2014. Patients with a primary diagnosis of bipolar affective disorder, schizophrenia, other chronic psychotic disorders, dementia or cognitive disorders, alcohol and substance use disorders, and those with missing data were excluded.ResultsInitial screening yielded a total of 115 patients. 64 patients were included in the study, 13 patients were excluded due to missing data, and 38 patients were excluded due to comorbidity.CharacteristicTotal (N=64) Last Episode CharacteristicsTotal (N=64)Female - N(%)44 (69)Episode duration – month (mean ± SD)13.75 ± 16.09Age – yr (mean ± SD)48.39 ± 18.81Psychotic symptoms – N(%)20 (31)Married – N(%)41 (64)Anxiety symptoms – N(%)24 (38)Secondary school and over – N(%)38 (59)Suicidal attempt – N(%)19 (30)Employed – N(%)16 (25)TRD definition and staging method (N=55) T&R ESM MSM MGH-S ConwayNot resistant by this method26 (47.3)45 (81.8)0 (0)27 (49.1)43 (78.2)Identified by this method29 (52.7)10 (18.2)55 (100)28 (50.9)12 (21.8)Exclusively identified by this method0 (0)0 (0)21 (38.2)0 (0)0 (0)By this and one other method27 (49.1)0 (0)11 (20)5 (9.1)0 (0)By all methods10 (18.2)10 (18.2)10 (18.2)10 (18.2)10 (18.2)Identified as TRDAge of onset (mean ± SD)40.28 ± 17.4235.6 ± 18.2740.44 ±18.3840.07 ± 17.938.17 ± 17.71ATHF score (mean ± SD)7.55 ± 5.4612.1 ± 6.514.93 ± 4.987.43 ± 5.6911.08 ± 6.47Last episode duration (month) (mean ± SD)17.11 ± 17.2522.10 ± 20.9614.22 ± 17.0816.33 ± 17.6620.83 ± 19.25Conclusions There is no universally agreed-upon definition for treatment resistance. In this sample, different definition and staging methods were employed to examine the similarities and differences in the clinical and treatment related characteristics of groups with TRD identified with each. The reasons and possible implication of concurrence and discordance between the methods will be discussed.Disclosure of InterestNone Declared