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Treatment resistance in severe unipolar depression: No association with psychotic or melancholic features

par Zaninotto, Leonardo;Serretti, Alessandro;Souery, Daniel ;Calati, Raffaella;Sentissi, Othman;Kasper, Siegfried;Akimova, Elena;Zohar, Joseph;Montgomery, Stuart;Mendlewicz, Julien
Référence Annals of clinical psychiatry, 25, 2, page (97-106)
Publication Publié, 2013-05

Article révisé par les pairs

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Résumé :

BACKGROUND: Depressive subtypes generally have been neglected in research on treatment efficacy. We studied a sample of 699 severe unipolar depressed patients to detect any association between depressive features and treatment resistance. METHODS: Participants were divided into psychotic (PSY, n = 90), melancholic (MEL, n = 430) and non-melancholic (n = 179) subjects according to clinical features. Formal diagnostic criteria (Mini International Neuropsychiatric Interview items), and items from 17-item Hamilton Rating Scale for Depression (HRSD17) were compared across groups. Non-responders were defined by a HRSD17 cut-off score of !17 after the last adequate antidepressant treatment. Treatment-resistant depression (TRD) was defined as the failure to respond to !2 adequate antidepressant trials. Non-linear regression models were designed to detect associations between depressive subtypes and TRD. RESULTS: PSY and MEL patients appeared to be more severely affected and to share some "core" melancholic symptoms. Both PSY and MEL patients reported a higher rate of seasonality. However, we found no clinical or illness course variable associated with TRD. CONCLUSIONS: Our results indicate that psychotic and melancholic depression share some "core" melancholia symptoms, while no distinguishing psychopathological feature appears to be associated with TRD in severely depressed patients.