Nearly half of depression patients struggle with treatment resistance

Almost half of patients diagnosed with depression classify as being 'treatment-resistant' as new research suggests that many don't respond to multiple antidepressant options.

The new study, published in the British Journal of Psychiatry was led by academics from the University of Birmingham and Birmingham and Solihull Mental Health NHS Foundation Trust. The study found that 48% of patients whose electronic healthcare records reported a diagnosis of depression had tried at least two antidepressants, and 37% had tried four or more different options. 

Treatment-resistant depression (TRD) is typically defined as a form of depression that isn't effectively managed after a patient tries two different antidepressants. There are currently few guidelines for treating TRD.

Patients who experience TRD were also invited to take part in interviews to share their experiences. Patients talked about a "sense of hopelessness" after trying multiple treatment options for the condition, and many shared their frustrations with a "one size fits all" approach to what works with treatment.

This paper highlights how widespread treatment-resistant depression is among those who are diagnosed with depression. With nearly half of all patients not responding to multiple drug options, we need better treatment options to be able to support patients for whom first line antidepressant medications don't make a difference.

Furthermore, the experiences of patients who took part in this study shows that more awareness and options for treating depression when first line antidepressant medications don't work well is urgently needed.

There is an irony that the experience of struggling to treat depression is in itself a risk factor for a worsening sense of 'hopelessness' as one patient described it. This should be a clarion call to recognise that treatment-resistant depression needs to be factored into clinical decision making and the ongoing support that patients are offered."

Kiranpreet Gill, PhD researcher from the School of Psychology at the University of Birmingham and corresponding author of the study

There are increased risks of other psychiatric disorders among those with TRD such as anxiety, self-harm, and personality disorders, and physical health issues such as heart disease. Data analysis suggests that patients with TRD have 35% higher odds of having a personality disorder and 46% higher odds of cardiovascular disease and the combination with qualitative data suggests that patients have multiple and considerable barriers to achieving good health.

Professor Steven Marwaha, Clinical Professorial Fellow at the Institute for Mental Health at the University of Birmingham, a Consultant Psychiatrist at Birmingham and Solihull Mental Health NHS Foundation Trust, and co-author of the study said:

"This study is important as the data demonstrates people with TRD are at a higher risk of a range of poorer outcomes, and that we need better defined care pathways for helping this population, and are in urgent need of developing and testing new treatments for this group."

This group's research is part of the Mental Health Mission Midlands Translational Centre, led by the University of Birmingham and funded by the National Institute for Health and Care Research, focusing on improving treatments for treatment-resistant depression in young, superdiverse, and deprived populations. The Centre aims to accelerate the development and delivery of innovative, evidence-based interventions to improve outcomes and reduce disparities in mental health care.