Study finds higher mortality risk in patients with treatment resistant depression

Importance of Early Psycho therapeutic Interventions

Patients with treatment-resistant depression have a 23 per cent higher risk of death than other depressed patients. They also have twice as much outpatient care and spend three times the number of days in inpatient care. These are findings of a new study published in JAMA Psychiatry by researchers from Karolinska Institutet and elsewhere, who conclude that it is important to identify patients at risk of developing treatment-resistant depression.   

Depression is the leading cause of functional disability the world over. The most common treatments are antidepressants or psychotherapy. Many sufferers need care for months or years, but a significant share of patients never recover despite two well-implemented treatment attempts. They have what is commonly called treatment-resistant depression.   

Researchers at Karolinska Institutet and the Centre for Psychiatric Research have now examined the effects of treatment-resistant depression in Region Stockholm at both an individual and societal level, something that has not been studied to the same extent previously.  

In the population-based observation study, the researchers used data from several sources, including Region Stockholm's administrative healthcare database and the Swedish Social Insurance Agency. Over 145,000 patients with depression in the Stockholm region were included in the study.   

Having identified 158,000 depressive episodes in these patients between 2012 and 2017, of which in excess of 12,000 were of a treatment-resistant nature, the researchers were able to draw a number of conclusions about what characterizes patients with treatment-resistant depression.   
They also found increased comorbidity with other psychiatric conditions, such as anxiety syndrome, insomnia, substance abuse syndrome and self-harm in the group with treatment-resistant depression.  

The researchers discovered that the risk of developing treatment-resistant depression could be predicted already at the first depression diagnosis. By far the most important prognostic factor was self-rated severity of depression. 

"We would benefit from identifying patients at risk of developing treatment-resistant depression, since it causes a great deal of personal suffering and is a burden for the whole of society," says Professor Johan Lundberg. 

It took an average of one and a half years for the patients with treatment-resistant depression to undergo the two treatment attempts, which is several months longer than is recommended for assessing the efficacy of a treatment for depression. Professor Lundberg says that a more frequent replacement of ineffective treatments would probably be of great help for this patient group. 

"We're talking about a patient group with a substantial health care consumption that might be identified earlier than today by increasing the use of symptom severity rating scales. Going by the results of the study, their care and treatment could be improved if their physician replaced ineffective treatments more rapidly and more often used treatments recommended for treatment-resistant depression, such as lithium, than was the case in the study material," says Professor Lundberg.   

The study was initiated and financed by Region Stockholm and carried out in association with the pharmaceutical company Janssen-Cilag.  

Lundberg, J., et al. (2022) Association of Treatment-Resistant Depression With Patient Outcomes and Health Care Resource Utilization in a Population-Wide Study. JAMA Psychiatry.
5 replies
  1. Paniz shhabazi
    Paniz shhabazi says:

    The difference between normal depression and resistant depression is this: resistant depression is those who take antidepressants, self-harm and substance abuse syndrome. And normal depression is grief or the loss of loved ones, a hopelessness that is eventually resolved with family support and therapy.
    It is true??

  2. Dorsa dehghani fard
    Dorsa dehghani fard says:

    The most common treatment for depression is drug therapy and psychotherapy. Some depressed patients show resistance to treatment, which is called treatment-resistant depression. Treatment-resistant patients experience anxiety syndrome, insomnia, substance abuse and self-harm more than others.
    The severity of depression causes resistance to treatment.
    The risk of death in treatment-resistant depression is higher than other depression

  3. Setare rezaei
    Setare rezaei says:

    Hi. It was an interesting article. Depression placing a higher percentage of young people or adolescents, or paying attention to this article, helps to depression and the importance of premature therapeutic interventions to help patients with the disease or even therapists.

  4. Niloofar khoshdel
    Niloofar khoshdel says:

    Good time, Dr. Malehi I am niloofar khoshdel from Iranian University. It was a very good article because in my opinion, sometimes resistance in any field can be a problem. For example, resistance to not accepting… But in my opinion, people who are resistant to treatment for depression can also have cognitive problems. Examining the personality of these people can be very helpful.


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