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.
Tavistock and Portman NHS Foundation Trust, London, UK; Research Department of Clinical, Educational and Health Psychology, University College London, UK.
J Affect Disord. 2024 Aug 1;358:292-301. doi: 10.1016/j.jad.2024.04.093. Epub 2024 Apr 30.
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.
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.
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.
Potential for recall bias, not examining possible interactions, and absence of a control group.
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.
最近的系统综述强调了治疗抵抗性抑郁症（TRD）的定义和评估存在很大差异。一个关键问题是，这些定义是基于共识，而非数据。本研究旨在为相关样本提供全面的社会人口学和临床描述。
作为一项实用随机对照试验的一部分，在初级保健中对持续性抑郁症患者（N=129）进行管理，并诊断为 TRD。数据包括先前的治疗尝试、抑郁疾病的特征、功能、生活质量、共病问题（包括自杀意念）、精神和人格障碍、身体健康状况以及不良事件。
研究结果显示，抑郁病程严重且慢性，患病时间超过 25 年。总体而言，82.9%的患者至少有另一种精神诊断，82.2%的患者至少有一种人格障碍；69.8%的患者有明显的肌肉骨骼、胃肠道、泌尿生殖或心血管和呼吸系统的身体健康问题。除 14 人外，所有人在社会和职业功能方面都有严重困难，并报告生活质量严重受损。自杀意念较高：44.9%的患者至少有过一次严重自杀企图，一些患者报告有多次自杀企图，其中 17.8%的患者在儿童或青少年时期曾试图自杀。患者中有 79.8%报告至少有一次不良的童年经历。
存在回忆偏倚的可能性、未检查可能的相互作用以及没有对照组。
我们的研究结果揭示了一种复杂和多方面的状况，呼吁对 TRD 进行紧急重新概念化，该概念涵盖了许多相互依存的变量和经历。患有 TRD 的个体在获得足够治疗方面可能处于严重劣势。
