Treatment-Resistant Depression in Poland-Epidemiology and Treatment.

Piotr Gałecki,Magdalena Mikułowska,Jerzy Samochowiec,Agata Szulc

doi:10.3390/jcm11030480

Abstract

(1) Background: Major depressive disorder (MDD) is one of the most prevalent psychiatric disorders worldwide. Although several antidepressant drugs have been developed, up to 30% of patients fail to achieve remission, and acute remission rates decrease with the number of treatment steps required. The aim of the current project was to estimate and describe the population of treatment-resistant depression (TRD) patients in outpatient clinics in Poland. (2) Methods: The project involved a representative sample of psychiatrists working in outpatient clinics, chosen through a process of quota random sampling. The doctors completed two questionnaires on a consecutive series of patients with MDD, which captured the patients’ demographics, comorbidities, and medical histories. TRD was defined as no improvement seen after a minimum of two different antidepressant drug therapies applied in sufficient doses for a minimum of 4 weeks each. The data were weighted and extrapolated to the population of TRD outpatients in Poland. (3) Results: A total of 76 psychiatrists described 1781 MDD patients, out of which 396 fulfilled the criteria of TRD. The TRD patients constituted 25.2% of all MDD patients, which led to the number of TRD outpatients in Poland being estimated at 34,800. The demographics, comorbidities, medical histories, and histories of treatment of Polish TRD patients were described. In our sample of the TRD population (mean age: 45.6 ± 13.1 years; female: 64%), the patients had experienced 2.1 ± 1.6 depressive episodes (including the current one), and the mean duration of the current episode was 4.8 ± 4.4 months. In terms of treatment strategies, most patients (around 70%) received monotherapy during the first three therapies, while combination antidepressant drugs (ADs) were applied more often from the fourth line of treatment. The use of additional medications and augmentation was reported in only up to one third of the TRD patients. During all of the treatment steps, patients most often received a selective serotonin reuptake inhibitor (SSRI) and a serotonin norepinephrine reuptake inhibitor (SNRI). (4) Conclusions: TRD is a serious problem, affecting approximately one fourth of all depressive patients and nearly 35,000 Poles.

Highlights

Out of the 1781 patients described in Part A of the questionnaire as having an active depressive episode, 396 fulfilled the definition of unipolar treatmentresistant depression (TRD) used in this study and were included in the analysis
We found thathospitalized the proportion of last the adult the current episode), and hospitalization lasted on A
We found that the proportion of TRD patients among the

Summary

Introduction

Major depressive disorder (MDD) is one of the most prevalent psychiatric disorders worldwide, especially in high-income regions [1,2,3,4,5]. It causes individual suffering, a loss of productivity and increased health care costs; it is associated with a high suicide risk [2]. MDD represents a major economic and medical burden for societies [1]. Depressive disorders directly account for 4.4% of the disease burden worldwide and 7.2%.

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