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Rost F, Booker T, Gonsard A, de Felice G, Asseburg L, Malda-Castillo J, Koutoufa I, Ridsdale H, Johnson R, Taylor D, Fonagy P. The complexity of treatment-resistant depression: A data-driven approach. J Affect Disord 2024; 358:292-301. [PMID: 38697222 DOI: 10.1016/j.jad.2024.04.093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Revised: 03/27/2024] [Accepted: 04/21/2024] [Indexed: 05/04/2024]
Abstract
BACKGROUND Recent systematic reviews highlight great variability in defining and assessing treatment-resistant depression (TRD). A key problem is that definitions are consensus rather than data-led. This study seeks to offer a comprehensive socio-demographic and clinical description of a relevant sample. METHODS As part of a pragmatic randomized controlled trial, patients (N = 129) were managed in primary care for persistent depression and diagnosed with TRD. Data included previous treatment attempts, characteristics of the depressive illness, functioning, quality of life, co-occurring problems including suicidality, psychiatric and personality disorders, physical health conditions, and adverse events. RESULTS Findings show a severe and chronic course of depression with a duration of illness of 25+ years. Overall, 82.9 % had at least one other psychiatric diagnosis and 82.2 % at least one personality disorder; 69.8 % had significant musculoskeletal, gastrointestinal, genitourinary, or cardiovascular and respiratory physical health problems. All but 14 had severe difficulties in social and occupational functioning and reported severely impaired quality of life. Suicidal ideation was high: 44.9 % had made at least one serious suicide attempt and several reported multiple attempts with 17.8 % reporting a suicide attempt during childhood or adolescence. Of the patients, 79.8 % reported at least one adverse childhood experience. LIMITATIONS Potential for recall bias, not examining possible interactions, and absence of a control group. CONCLUSIONS Our findings reveal a complex and multifaceted condition and call for an urgent reconceptualization of TRD, which encompasses many interdependent variables and experiences. Individuals with TRD may be at a serious disadvantage in terms of receiving adequate treatment.
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Affiliation(s)
- Felicitas Rost
- Tavistock and Portman NHS Foundation Trust, London, UK; The Open University, School of Psychology and Psychotherapy, Faculty of Arts and Social Sciences, Milton Keynes, UK.
| | - Thomas Booker
- Tavistock and Portman NHS Foundation Trust, London, UK; Research Department of Clinical, Educational and Health Psychology, University College London, UK
| | | | | | | | | | | | | | | | - David Taylor
- Tavistock and Portman NHS Foundation Trust, London, UK
| | - Peter Fonagy
- Research Department of Clinical, Educational and Health Psychology, University College London, UK
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Krylova ES. [First depressive episode in the dynamics of personality disorders in adolescence]. Zh Nevrol Psikhiatr Im S S Korsakova 2021; 121:35-40. [PMID: 34405655 DOI: 10.17116/jnevro202112105235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To determine clinical and psychopathological specifics of the first depressive episode (DE) in the context of formation of personality anomalies and their dynamics in adolescence. MATERIAL AND METHODS Two hundred and thirty-seven patients (180 male, 57 female), aged 16 to 25 years, with the first DE and comorbid personality disorder (PD) were clinically observed and psychopathologically evaluated. Later 149 patients from this group participated in the follow-up study. RESULTS The first DE with PD in adolescence is characterized by psychopathological variety due to PD type and age factor. Diagnosis of PD in adolescence is based on pathological traits, while affective impairment is a separate dimension. PD determines the clinical features of the first DE and all spectrum of affective disorders. The high conjugation of the first DE with autoagressive behavior confirms their suicidal risk. Autoagressive behavior is noted in 201 (84.8%) patients, of which 59 (29.4%) had non-suicide self-injury (NSSI) and 14 (70.6%) had suicidal activity. The follow-up study identified variants of further dynamics of PD with comorbid affective spectrum disorders after the first DE developed in youth that had prognostic value: unipolar major depression in schizoid PD (13 (37.1%) patients), cluster C PD (8 (26.7%)); bipolar affective disorders in borderline (42 (28.2%)) and narcissistic (16 (40.0%)) PD; recurrent depressive disorder in PD of cluster C (14 (46.7%)). CONCLUSIONS The revealed clinical and psychopathological features will contribute to the creation of a unified model for predicting affective disorders and the formation of therapy standards.
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Affiliation(s)
- E S Krylova
- Mental Health Research Center, Moscow, Russia
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Kavanagh BE, Ashton MM, Cowdery SP, Dean OM, Turner A, Berk M, Gwini SM, Brennan-Olsen SL, Koivumaa-Honkanen H, Chanen AM, Williams LJ. Systematic review and meta-analysis of the role of personality disorder in randomised controlled trials of pharmacological interventions for adults with mood disorders. J Affect Disord 2021; 279:711-721. [PMID: 33197840 DOI: 10.1016/j.jad.2020.10.031] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Revised: 08/26/2020] [Accepted: 10/12/2020] [Indexed: 01/07/2023]
Abstract
BACKGROUND Personality disorder (PD) may affect the efficacy of pharmacological interventions for mood disorders, but the extent to which this occurs is uncertain. We aimed to examine the available published evidence concerning the role of PD in pharmacological treatment outcomes of randomised controlled trials (RCTs) for adults with mood disorders (i.e. depressive and bipolar spectrum disorders). METHODS A systematic search of Cochrane Central Register of Controlled Clinical Trials, PubMed, EMBASE, PsycINFO, CINAHL Complete, and Google Scholar databases was undertaken to identify studies of interest. Data were independently extracted by two reviewers. The Cochrane Risk of Bias tool was used to assess methodological quality and risk of bias. A random effects model was utilised and statistical heterogeneity was assessed using the I2 statistic. This systematic review was registered with PROSPERO (CRD42018089279) and the protocol is published. RESULTS The search yielded 11,640 studies. Subsequent to removing duplicates, 9657 studies were screened at title and abstract stage and 1456 were assessed at full-text stage. Eighteen studies met criteria for inclusion in this review. Meta-analysis did not reveal a significant difference between groups for treatment outcome (standardised mean difference 0.22 [-0.09, 0.54]; I2: 69%, p=0.17) and remission (risk ratio 0.84 [0.64, 1.11]; I2: 51%, p=0.22). LIMITATIONS This review was limited by lack of studies on bipolar disorder. CONCLUSION PD comorbidity does not appear to affect treatment efficacy of pharmacological interventions for adults with mood disorders.
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Affiliation(s)
- Bianca E Kavanagh
- Deakin University, Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Barwon Health, Geelong, Australia.
| | - Melanie M Ashton
- Deakin University, Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Barwon Health, Geelong, Australia
| | - Stephanie P Cowdery
- Deakin University, Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Barwon Health, Geelong, Australia
| | - Olivia M Dean
- Deakin University, Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Barwon Health, Geelong, Australia; Florey Institute for Neuroscience and Mental Health, University of Melbourne, Kenneth Myer Building, Parkville, Australia
| | - Alyna Turner
- Deakin University, Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Barwon Health, Geelong, Australia; School of Medicine and Public Health, Faculty of Health and Medicine, the University of Newcastle, Callaghan, Australia
| | - Michael Berk
- Deakin University, Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Barwon Health, Geelong, Australia; Florey Institute for Neuroscience and Mental Health, University of Melbourne, Kenneth Myer Building, Parkville, Australia; Department of Psychiatry University of Melbourne, The Melbourne Clinic, Professorial Unit, Richmond, Australia; Orygen, Melbourne, Australia; Centre for Youth Mental Health, the University of Melbourne, Parkville, Australia
| | - Stella M Gwini
- Deakin University, Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Barwon Health, Geelong, Australia; University Hospital Geelong, Barwon Health, Geelong, Australia
| | - Sharon L Brennan-Olsen
- Deakin University, School of Health and Social Development, Geelong, Australia; Deakin University, Institute for Health Transformation, Geelong, Australia
| | - Heli Koivumaa-Honkanen
- Institute of Clinical Medicine (Psychiatry), University of Eastern Finland, Kuopio, Finland; Department of Psychiatry, Kuopio University Hospital, Kuopio, Finland; Department of Psychiatry, Oulu University Hospital, Finland
| | - Andrew M Chanen
- Orygen, Melbourne, Australia; Centre for Youth Mental Health, the University of Melbourne, Parkville, Australia
| | - Lana J Williams
- Deakin University, Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Barwon Health, Geelong, Australia
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