European Psychiatry (Jun 2022)

Resistance or pseudo-resistance?

  • R. Zanardi,
  • F. Attanasio,
  • C. De Cesare,
  • V. Fazio,
  • C. Colombo

DOI
https://doi.org/10.1192/j.eurpsy.2022.941
Journal volume & issue
Vol. 65
pp. S370 – S371

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 Age 59.1±11.9 63.0±12.6 57.0±11.3 0.036* Episodes of illness 3.8±2.1 4.0±1.9 3.0±1.8 0.036* Personality disorders 27.0% 18.9% 48.6% 0.009** Therapies: 0.014** SSRI 62.4% 40.4% 69.7% SNRI 19.8% 42.3% 15.1% TCA 17.8% 17.3% 15.1% Augmentation 24.3% 38.9% 17.1% 0.05** Remission 76.5% 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.

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