Personality Traits as Risk Factors for Treatment-Resistant Depression

Michio Takahashi,Masatoshi Suzuki,Kenji Hashimoto,Yukihiko Shirayama,Koichi Sato,Katsumasa Muneoka,Takeo Yoshikawa

doi:10.1371/journal.pone.0063756

Abstract

BackgroundThe clinical outcome of antidepressant treatment in patients with major depressive disorder (MDD) is thought to be associated with personality traits. A number of studies suggest that depressed patients show high harm avoidance, low self-directedness and cooperativeness, as measured on the Temperament and Character Inventory (TCI). However, the psychology of these patients is not well documented.MethodsPsychological evaluation using Cloninger’s TCI, was performed on treatment-resistant MDD patients (n = 35), remission MDD patients (n = 31), and age- and gender-matched healthy controls (n = 174).ResultsTreatment-resistant patients demonstrated high scores for harm avoidance, and low scores for reward dependence, self-directedness, and cooperativeness using the TCI, compared with healthy controls and remission patients. Interestingly, patients in remission continued to show significantly high scores for harm avoidance, but not other traits in the TCI compared with controls. Moreover, there was a significant negative correlation between reward dependence and harm avoidance in the treatment-resistant depression cohort, which was absent in the control and remitted depression groups.ConclusionsThis study suggests that low reward dependence and to a lesser extent, low cooperativeness in the TCI may be risk factors for treatment-resistant depression.

Highlights

Antidepressants are commonly used in the treatment of major depressive disorder (MDD)
Subsequent one-way analysis of variance (ANOVA) demonstrated that treatment-resistant patients showed significantly altered scores on harm avoidance, reward dependence, self-directedness and cooperativeness, but not novelty seeking, persistence, or selftranscendence compared with remitted depression patients and healthy controls (Figure 1)
There were no correlations between Temperament and Character Inventory (TCI) scores and

Summary

Introduction

Antidepressants are commonly used in the treatment of major depressive disorder (MDD). The 5 to 15 percent of patients who do not respond to treatment are deemed to have treatment-resistant depression [1]. It is noteworthy that response is defined as a reduction to less than 50 percent in depressive symptoms, but not necessarily recovery. Remission is defined as a full recovery, classified as a score of less than 7 on the Hamilton Rating Scale for Depression (HAM-D) [1]. The clinical outcome of antidepressant treatment in patients with major depressive disorder (MDD) is thought to be associated with personality traits. A number of studies suggest that depressed patients show high harm avoidance, low self-directedness and cooperativeness, as measured on the Temperament and Character Inventory (TCI). The psychology of these patients is not well documented

Objectives

Results

Conclusion