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Resistance or pseudo-resistance?

Published online by Cambridge University Press:  01 September 2022

R. Zanardi ,
F. Attanasio ,
C. De Cesare ,
V. Fazio  and
C. Colombo
R. Zanardi
Affiliation:
IRCCS San Raffaele Scientific Institute, Psychiatry - Mood Disorders, Milano, Italy
F. Attanasio*
Affiliation:
Università Vita-Salute San Raffaele, Psychiatry, Milano, Italy
C. De Cesare
Affiliation:
Università Vita-Salute San Raffaele, Psychiatry, Milano, Italy
V. Fazio
Affiliation:
Università Vita-Salute San Raffaele, Psychiatry, Milano, Italy
C. Colombo
Affiliation:
IRCCS San Raffaele Scientific Institute, Psychiatry - Mood Disorders, Milano, Italy Università Vita-Salute San Raffaele, Psychiatry, Milano, Italy
*
*Corresponding author.

Abstract

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Introduction

Treatment-Resistant Depression continues to represent a great challenge for clinicians.

Objectives

We investigated patients with history of resistance, assessing prognostic factors, response to treatments, and remission over time.

Methods

We recruited 202 unipolar and bipolar depressed inpatients. According to anamnestic backgrounds, patients were assigned to: A) Non-resistant: responders, with no characteristics of resistance in the current episode. B) Resistant: resistant to two antidepressant trials of adequate doses and duration. C) Pseudo-resistant: non-responders, not classifiable as Resistant because of inadequate trials. During hospitalization, patients were treated by clinical judgment, following a rehabilitation program.

Results

Table 1
Non-resistant (111)Resistant (54)Pseudo-resistant (35)p-value
Age59.1±11.963.0±12.657.0±11.30.036*
Episodes of illness3.8±2.14.0±1.93.0±1.80.036*
Personality disorders27.0%18.9%48.6%0.009**
Therapies:0.014**
SSRI62.4%40.4%69.7%
SNRI19.8%42.3%15.1%
TCA17.8%17.3%15.1%
Augmentation24.3%38.9%17.1%0.05**
Remission76.5%59.5%81.2%CvsB:0.045** CvsA:0.587**

On the day of admission, non-responders were 44.5% of the sample, but 39.3% of them did not meet the Resistant criteria, defining the Pseudo-resistant group. Pseudo-resistant differed from others by younger age, fewer illness episodes, higher rate of personality disorders, and different therapies during hospitalization [Fig.1,2,3]. Pseudo-resistant remission rate, significantly greater than Resistant one, was comparable to Non-resistant [Tab.1]. *Kruskal-Wallis Test **Chi-Squared Test

Conclusions

This study outlines a new group of depressed patients that, apparently drug-resistant, displays the same outcome as responders when treated with first-line drugs during hospitalization, certainly taking benefit from the psychoeducational program. Quick recognition of these patients could be crucial to giving optimal care.

Disclosure

No significant relationships.

Keywords

bipolar disorderpseudo-resistancedepressive disordertreatment resistant depression
Type
Abstract
Information
European Psychiatry , Volume 65 , Special Issue S1: Abstracts of the 30th European Congress of Psychiatry , June 2022 , pp. S370 - S371
Creative Commons
Creative Common License - CCCreative Common License - BY
This is an Open Access article, distributed under the terms of the Creative Commons Attribution licence (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted re-use, distribution, and reproduction in any medium, provided the original work is properly cited.
Copyright
© The Author(s), 2022. Published by Cambridge University Press on behalf of the European Psychiatric Association
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