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Signs Risk for Resistant Depression Cheat Sheet (DRAFT) by [deleted]

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...

1. Duration

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

2. Severity

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

5. Comorb­idity

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.