Prospective, long-term, multicenter study of the naturalistic outcomes of patients with treatment-resistant depression

David L. Dunner, A. John Rush, James M. Russell, Michael Burke, Stacy Woodard, Peggy Wingard, John JB Allen

Research output: Contribution to journalArticle

123 Citations (Scopus)

Abstract

Background: Treatment-resistant depression (TRD) is a long-term, disabling illness. We report on the characteristics and outcomes of a large cohort of patients with a level of treatment resistance that is very substantial and who were treated for 2 years with standard care. Method: This 2-year prospective, multicenter, observational study (patients enrolled from January 2001 through July 2004) tracked the outcomes of 124 patients with treatment-resistant, nonpsychotic major depressive disorder (N = 109) or bipolar depressed phase disorder (N = 15) who received treatment as usual (TAU) (i.e., any therapeutic regimen agreed to by patients and psychiatrists, including medications, electroconvulsive therapy [ECT], and psychotherapy). Treatments could be adjusted, started, and stopped as necessary. The primary outcome, treatment response, was defined a priori as ≥ 50% improvement from baseline as measured by the 30-item Inventory of Depressive Symptomatology-Self-Report (IDS-SR-30). Remission was defined as an IDS-SR-30 score of ≤ 14. The Medical Outcomes Study (MOS) 36-item Short Form Health Survey (SF-36) was used to monitor quality-of-life changes. Results: The 12- and 24-month IDS-SR-30 response rates were 11.6% (13/112) and 18.4% (19/103), respectively. Of the 13 responders at 12 months, only 5 were responders at 24 months. The 12- and 24-month IDS-SR-30 remission rates were 3.6% (4/112) and 7.8% (8/103), respectively. Only 1 of the 4 12-month remitters was also a remitter at 24 months. The SF-36 indicated globally poor quality of life in this sample. Conclusions: Despite the wide range of treatment options available for depression, the response rates, remission rates, and quality-of-life results in this study show that most patients with a substantial degree of treatment resistance continue to have significant symptomatology and functional disability when receiving TAU.

Original languageEnglish (US)
Pages (from-to)688-695
Number of pages8
JournalJournal of Clinical Psychiatry
Volume67
Issue number5
DOIs
StatePublished - Jan 1 2006
Externally publishedYes

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Treatment-Resistant Depressive Disorder
Multicenter Studies
Quality of Life
Therapeutics
Electroconvulsive Therapy
Major Depressive Disorder
Health Surveys
Psychotherapy
Self Report
Observational Studies
Psychiatry
Outcome Assessment (Health Care)
Depression
Equipment and Supplies
IDS 30

ASJC Scopus subject areas

  • Psychiatry and Mental health

Cite this

Prospective, long-term, multicenter study of the naturalistic outcomes of patients with treatment-resistant depression. / Dunner, David L.; Rush, A. John; Russell, James M.; Burke, Michael; Woodard, Stacy; Wingard, Peggy; Allen, John JB.

In: Journal of Clinical Psychiatry, Vol. 67, No. 5, 01.01.2006, p. 688-695.

Research output: Contribution to journalArticle

Dunner, David L. ; Rush, A. John ; Russell, James M. ; Burke, Michael ; Woodard, Stacy ; Wingard, Peggy ; Allen, John JB. / Prospective, long-term, multicenter study of the naturalistic outcomes of patients with treatment-resistant depression. In: Journal of Clinical Psychiatry. 2006 ; Vol. 67, No. 5. pp. 688-695.
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