Signs Patient is at Risk for TRD
This is a draft cheat sheet. It is a work in progress and is not finished yet.
What factors predispose patients to TRD and what treatment strategies achieve response? Decades of research have focused on the identification of risk factors associated with TRD.
The 6 most reliable are...
Duration of the episode: the longer the episode of depression, the greater the atrophy in specific brain regions (eg, hippocampus); the cognitive and behavioral changes that take place during long episodes make a return to previous well-being difficult
Severity of the episode: both ends of the depression spectrum (most severe, mildest) are hypothesized to increase the risk of poor response—severe depression is associated with biological unbalances; mild depression, with lower drug versus placebo response
3. Melancholic features
Melancholic features: TRD is more prevalent in bipolar depression than in MDD; the specific investigation of subthreshold manic symptoms is pivotal
4. Little improvement
Lack of symptomatic improvement within the first couple of weeks since the start of treatment.
Treatment Resistant Depression Predictors
Comorbidity: Anxious symptoms and full anxiety disorders (especially generalized anxiety disorder) were found to be predictors of lower rates of response and remission; personality disorders, especially avoidant and borderline, are negative prognostic factors.
6. Old age
Old age, long duration of an episode, anxiety symptoms, and major life events can contribute to TRD.