Student, Departments of Pharmaceutical Sciences and Neuroscience, University of Toronto, Toronto, Ontario; Clinical Research Coordinator, Department of Psychiatry, University Health Network, Toronto, Ontario.
Chief Operating Officer and Chief Financial Officer, Canadian Heart Research Centre, Toronto, Ontario.
Can J Psychiatry. 2014 Jul;59(7):349-57. doi: 10.1177/070674371405900702.
Treatment-resistant depression (TRD) represents a considerable global health concern. The goal of the InSight study was to investigate the prevalence of TRD and to evaluate its clinical characterization and management, compared with nonresistant depression, in primary care centres.
Physicians completed a case report on a consecutive series of patients with major depressive disorder (n = 1212), which captured patient demographics and comorbidity, as well as current and past medication.
Using failure to respond to at least 2 antidepressants (ADs) from different classes as the definition of TRD, the overall prevalence was 21.7%. There were no differences in prevalence between men and women or among ethnicities. Patients with TRD had longer episode duration, were more likely to receive polypharmacy (for example, psychotropic, lipid-lowering, and antiinflammatory agents), and reported more AD related side effects. Higher rates of disability and comorbidity (axes I to III) were associated with treatment resistance. Obesity and being overweight were also associated with treatment resistance. While the selection and sequencing of pharmacotherapy by family physicians in this sample was in line with recommendations from evidence-based treatment guidelines, the wait time to make a change in treatment was 6 to 8 weeks in both groups, which exceeds guideline recommendations.
These real-world data demonstrate the high prevalence of TRD in primary care settings, and underscore the substantial burden of illness associated with TRD.
治疗抵抗性抑郁症（TRD）是一个相当严重的全球健康问题。InSight 研究的目的是调查初级保健中心 TRD 的患病率，并评估其与非抵抗性抑郁症相比的临床特征和管理。
医生对一系列连续的重度抑郁症患者（n=1212）进行了病例报告，报告内容包括患者的人口统计学和合并症，以及当前和既往的用药情况。
将对至少两种不同类别的抗抑郁药（ADs）无反应定义为 TRD，其总体患病率为 21.7%。男女之间或不同种族之间的患病率没有差异。TRD 患者的发病时间更长，更有可能接受多种药物治疗（例如，精神药物、降脂药物和抗炎药物），并报告更多与 AD 相关的副作用。更高的残疾和合并症（轴 I 至 III）发生率与治疗抵抗有关。肥胖和超重也与治疗抵抗有关。虽然该样本中的家庭医生在选择和安排药物治疗方面符合循证治疗指南的建议，但两组的治疗变更等待时间均为 6 至 8 周，超过了指南的建议。
这些真实世界的数据表明，TRD 在初级保健环境中的患病率很高，并强调了与 TRD 相关的疾病负担。
