BARCELONA – Four potent clinical predictors of treatment-resistant depression have been confirmed in a validation study that showed the four factors collectively have a predictive accuracy of 87%, Alexander Kautzky, MD, reported at the annual congress of the European College of Neuropsychopharmacology.
The four predictors – all easily assessed – are symptom severity, which was independently associated with a 3.3-fold increased likelihood of treatment-resistant depression (TRD) in a study of 916 patients with major depression at 10 referral centers in eight European countries; suicidal risk, with a 1.74-fold increased risk; comorbid anxiety disorder, with a 1.68-fold increased risk; and the lifetime number of major depressive episodes, for which the associated TRD risk climbs by 15% per prior episode, according to Dr. Kautzky of the Medical University of Vienna.
When these four predictors were put to the test in an independent validation cohort of 314 patients with major depression, the four clinical markers of TRD exhibited a sensitivity of 86%, a specificity of 88%, and an overall predictive accuracy of 87%.
In these studies, Response was defined as at least a 50% drop in MADRS score to below 22 points.
The validation of these clinical predictors of TRD is a welcome development in psychiatry. The World Health Organization ranks major depressive disorder as the No. 4 cause of disease burden worldwide, and an impressive number of antidepressant medications are available, but up to 60% of patients do not respond sufficiently to their first round of antidepressant therapy. And there is a notable absence of biological markers to aid in selecting the best initial antidepressant for a given individual, Dr. Kautzky observed.
The validation study was supported by an unrestricted research grant from Lundbeck to a European research consortium known as the Group for the Study of Resistant Depression. Dr. Kautzky reported having no financial conflicts of interest.