Murao Masami, Matsumoto Yasuyuki, Kurihara Mariko, Oe Yuki, Nagashima Izumi, Hayasaka Tomonari, Tsuboi Takashi, Watanabe Koichiro, Sakurai Hitoshi
Department of Neuropsychiatry, Kyorin University Faculty of Medicine, Tokyo, Japan.
Department of Occupational Therapy, Kyorin University Faculty of Health Sciences, Tokyo, Japan.
Front Psychiatry. 2024 Aug 21;15:1371242. doi: 10.3389/fpsyt.2024.1371242. eCollection 2024.
Difficult-to-treat depression (DTD) represents a broad spectrum of patients with persistent depression where standard treatment modalities are insufficient, yet specific characteristics of this group remain insufficiently understood. This investigation aims to delineate the sociodemographic and clinical profiles of suspected DTD patients in real-world clinical settings.
We conducted a retrospective analysis of data from patients comprehensively evaluated for suspected DTD at Kyorin University Hospital, Tokyo, Japan, between October 2014 and September 2018. The study participants consisted of individuals with persistent depression unresponsive to conventional antidepressant treatments during the current episode. Diagnoses adhered to the criteria of the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision. Additional evaluations included the Montgomery-Åsberg Depression Rating Scale (MADRS) and other pertinent measures. The analysis focused on comparing demographic and clinical characteristics across diagnosed groups.
The analysis encompassed 122 patients, with diagnoses of major depressive disorder (MDD) in 41.8%, bipolar disorder (BD) in 28.7%, and subthreshold depression in 29.5%. Notably, high incidences of psychiatric comorbidities were present across all groups, with anxiety disorders exceeding 30% and personality disorders surpassing 50%. The only significant distinction among the three groups was observed in the MADRS scores, with the MDD group exhibiting the highest values (20.9 ± 9.7 vs. 18.6 ± 9.3 vs. 11.3 ± 7.4, p<0.01).
This study sheds light on the intricate nature of suspected DTD, emphasizing the coexistence of MDD, BD, and subthreshold depression within this category. Our findings underscore the necessity for thorough evaluations and tailored treatment approaches for managing suspected DTD.
难治性抑郁症（DTD）涵盖了广泛的持续性抑郁症患者群体，在这些患者中，标准治疗方式并不充分，但对这一群体的具体特征仍了解不足。本研究旨在描绘现实临床环境中疑似DTD患者的社会人口学和临床特征。
我们对2014年10月至2018年9月期间在日本东京杏林大学医院接受全面评估的疑似DTD患者的数据进行了回顾性分析。研究参与者包括在当前发作期间对传统抗抑郁治疗无反应的持续性抑郁症患者。诊断遵循《精神障碍诊断与统计手册》第四版修订版的标准。额外评估包括蒙哥马利-阿斯伯格抑郁评定量表（MADRS）和其他相关测量。分析重点是比较各诊断组的人口统计学和临床特征。
分析涵盖了122名患者，其中重度抑郁症（MDD）诊断占41.8%，双相情感障碍（BD）诊断占28.7%，阈下抑郁症诊断占29.5%。值得注意的是，所有组中精神共病的发生率都很高，焦虑症超过30%，人格障碍超过50%。三组之间唯一显著的差异体现在MADRS评分上，MDD组得分最高（20.9±9.7 vs. 18.6±9.3 vs. 11.3±7.4，p<0.01）。
本研究揭示了疑似DTD的复杂本质，强调了MDD、BD和阈下抑郁症在这一类别中的共存。我们的研究结果强调了对疑似DTD进行全面评估和量身定制治疗方法的必要性。
