6 Signs Your Patient Is at Risk for Treatment-Resistant Depression
What factors predispose patients to TRD and what treatment strategies achieve response? Find out here, with a bonus case vignette.
Duration of the episode: the longer the episode of depression, the greater the atrophy in specific brain regions (eg, hippocampus); the cognitive and behavioral changes that take place during long episodes make a return to previous well-being difficult
Severity of the episode: both ends of the depression spectrum (most severe, mildest) are hypothesized to increase the risk of poor response-severe depression is associated with biological unbalances; mild depression, with lower drug versus placebo response
Melancholic features: TRD is more prevalent in bipolar depression than in MDD; the specific investigation of subthreshold manic symptoms is pivotal
Lack of symptomatic improvement within the first couple of weeks since the start of treatment
Comorbidity: anxious symptoms and full anxiety disorders (especially generalized anxiety disorder) were found to be predictors of lower rates of response and remission; personality disorders, especially avoidant and borderline, are negative prognostic factors
Old age, long duration of an episode, anxiety symptoms, and major life events can contribute to TRD.
For more information, see Factors That Predispose Patients to Treatment-Resistant Depression, on which this slideshow was based