Investigation of early and lifetime clinical features and comorbidities for the risk of developing treatment-resistant depression in a 13-year nationwide cohort study
Journal
BMC Psychiatry
Journal Volume
20
Journal Issue
1
ISSN
1471-244X
Date Issued
2020
Author(s)
Abstract
Background: To investigate the risk of treatment-resistant depression (TRD) in patients with depression by examining their clinical features, early prescription patterns, and early and lifetime comorbidities. Methods: In total, 31,422 depressive inpatients were followed-up from diagnostic onset for more than 10-years. Patients were diagnosed with TRD if their antidepressant treatment regimen was altered ≥two times or if they were admitted after at least two different antidepressant treatments. Multiple Cox regression model were used to determine whether physical and psychiatric comorbidities, psychosis, and prescription patterns increased the risk of TRD by controlling for relevant demographic covariates. Survival analyses were performed for important TRD-associated clinical variables. Results: Females with depression (21.24%) were more likely to suffer from TRD than males (14.02%). Early anxiety disorders were more commonly observed in the TRD group than in the non-TRD group (81.48 vs. 58.96%, p < 0.0001). Lifetime anxiety disorders had the highest population attributable fraction (42.87%). Seventy percent of patients with multiple psychiatric comorbidities developed TRD during follow-up. Cox regression analysis further identified that functional gastrointestinal disorders significantly increased TRD risk (aHR = 1.19). Higher doses of antidepressants and benzodiazepines and Z drugs in the early course of major depressive disorder increased TRD risk (p < 0.0001). Conclusion: Our findings indicate the need to monitor early comorbidities and polypharmacy patterns in patients with depression associated with elevated TRD risk.
Subjects
Antidepressants; Early and lifetime comorbidities; Health-seeking behavior; Prescription pattern; Treatment-resistant depression
SDGs
Other Subjects
antidepressant agent; benzodiazepine derivative; antidepressant agent; adult; anxiety disorder; Article; comorbidity; controlled study; demography; digestive system function disorder; female; follow up; hospital admission; human; major clinical study; male; medical research; prescription; psychosis; risk factor; treatment resistant depression; cohort analysis; depression; major depression; treatment resistant depression; Antidepressive Agents; Cohort Studies; Depression; Depressive Disorder, Major; Depressive Disorder, Treatment-Resistant; Female; Humans; Male
Publisher
Springer Science and Business Media {LLC}
Type
journal article