OBJECTIVES

Treatment resistant depression (TRD), defined by failure to respond to ≥2 different antidepressants in the same major depressive episode (MDE), comes with considerable direct and indirect costs.¹ Despite significant economic burden, few studies report healthcare resource utilization of TRD patients in routine practice.¹ This study examined treatment outcomes and medical resource use of TRD patients in Europe.

METHODS

A prospective, multicenter, observational cohort study was conducted in adult TRD patients with Montgomery-Åsberg Depression Rating Scale (MADRS) score ≥20 and initiating a new antidepressive treatment. Patient characteristics, treatment outcomes and medical resource utilization were collected from medical records, clinician-rated interviews and patient-reported questionnaires. Response and remission were defined as ≥50% reduction in MADRS from baseline and MADRS ≤10 respectively.

RESULTS

After six months, 81/306 (26.5%) patients reached response while 51/306 (16.7%) achieved remission. The average Sheehan Disability Scale score was 6.2 in remitters, 16.8 in responders and 20.0 in non-responders. While 5.9% of remitters, 8.6% of responders and 8.6% of non-responders were hospitalized between baseline and month 6, the average length of stay in days was higher in non-responders (20.3) compared to responders (13.3) and remitters (8.7). Additionally, fewer remitters and responders had ICU visits compared to non-responders (3.9%; 4.9%; 7.2% respectively). Finally, remitters and responders were less likely to have outpatient consultations (psychiatrist, psychologist, general practitioner, etc.) compared to non-responders (49.0% vs 53.5% vs 57.5% respectively) and their number of outpatient consultations was also generally lower.

CONCLUSIONS

At Month 6, nearly three-quarters of TRD patients showed no response to standard of care and only 16.7% remission. Reaching response and especially remission was associated with a lower degree of functioning and productivity impairment healthcare resources use. This suggests that treatment failure considerably increases indirect and direct costs related to management of TRD.