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Treatment-resistant depression: when should we consider bipolarity?

Author/s
Nefize Yalin MD, Allan H. Young
Citation
Issue 5 Winter 2018
CEPiP.2018.1.126-129
Abstract

Despite effective pharmacotherapeutic and psychosocial strategies, approximately one third of adequately treated depressive patients do not reach remission and are considered treatment resistant. There are several factors associated with treatment-resistant depression (TRD). Underlying bipolarity is one of the important causes of TRD as it leads to a delayed diagnosis of bipolar disorder and inappropriate treatment. Assessment of bipolar features in every patient diagnosed with major depressive disorder (MDD), specifically in patients with TRD, is crucial. In the presence of bipolar features, interventions for TRD should be carried out carefully.

Cite as: Cutting Edge Psychiatry in Practice 2018, 5(1):126-129; https://doi.org/10.65031/nhlk4135

References

  1. Whiteford HA, Degenhardt L, Rehm J, Baxter AJ, Ferrari AJ, Erskine HE, Charlson FJ, Norman RE, Flaxman AD, Johns N, Burstein R. Global burden of disease attributable to mental and substance use disorders: findings from the Global Burden of Disease Study 2010. The Lancet. 2013 Nov 9;382(9904):1575-86. https://doi.org/10.1016/s0140-6736(13)61611-6
  2. Bromet E, Andrade LH, Hwang I, Sampson NA, Alonso J, De Girolamo G, De Graaf R, Demyttenaere K, Hu C, Iwata N, Karam AN. Cross-national epidemiology of DSM-IV major depressive episode. BMC Medicine. 2011 Dec;9(1):90. https://doi.org/10.1186/1741-7015-9-90
  3. National Institute for Health and Care Excellence (NICE). Depression in adults quality standard [QS8]. National Institute for Health and Care Excellence; 2011.
  4. De Carlo V, Calati R, Serretti A. Socio-demographic and clinical predictors of non-response/non-remission in treatment resistant depressed patients: a systematic review. Psychiatry Research. 2016 Jun 30;240:421-30. https://doi.org/10.1016/j.psychres.2016.04.034
  5. Rush AJ, Trivedi MH, Wisniewski SR, Nierenberg AA, Stewart JW, Warden D, Niederehe G, Thase ME, Lavori PW, Lebowitz BD, McGrath PJ. Acute and longer-term outcomes in depressed outpatients requiring one or several treatment steps: a STAR* D report. American Journal of Psychiatry. 2006 Nov;163(11):1905-17. https://doi.org/10.1176/ajp.2006.163.11.1905
  6. Guideline on clinical investigation of medicinal products in the treatment of depress [Internet]. European Medicines Agency; 2013 [cited 14 December 2018]. Available from: https://www.ema.europa.eu/documents/ scientific-guideline/guideline-clinical-investigation-medicinal-products-treatment-depression_en.pdf https://doi.org/10.1007/s00125-024-06162-z
  7. Cleare A, Pariante CM, Young AH, Anderson IM, Christmas D, Cowen PJ, Dickens C, Ferrier IN, Geddes J, Gilbody S, Haddad PM. Evidence-based guidelines for treating depressive disorders with antidepressants: a revision of the 2008 British Association for Psychopharmacology guidelines. Journal of Psychopharmacology. 2015 May;29(5):459-525. https://doi.org/10.1177/0269881115581093
  8. Ruhé HG, van Rooijen G, Spijker J, Peeters FP, Schene AH. Staging methods for treatment resistant depression. A systematic review. Journal of Affective Disorders. 2012 Mar 1;137(1-3):35-45. https://doi.org/10.1016/j.jad.2011.02.020
  9. Trevino K, McClintock SM, Fischer NM, Vora A, Husain MM. Defining treatment-resistant depression: a comprehensive review of the literature. Annals of Clinical Psychiatry 2014 Aug 1;26(3):222-32. https://doi.org/10.1177/104012371402600310
  10. Bennabi D, Aouizerate B, El-Hage W, Doumy O, Moliere F, Courtet P, Nieto I, Bellivier F, Bubrovsky M, Vaiva G, Holztmann J. Risk factors for treatment resistance in unipolar depression: a systematic review. Journal of Affective Disorders. 2015 Jan 15;171:137-41. https://doi.org/10.1016/j.jad.2014.09.020
  11. Taylor M, Bressan RA, Pan Neto P, Brietzke E. Early intervention for bipolar disorder: current imperatives, future directions. Revista Brasileira de Psiquiatria (Sao Paulo, Brazil : 1999). 2011;33 Suppl 2:s197-212. https://doi.org/10.1590/s1516-44462011000600006
  12. Post RM, Leverich GS, Kupka RW, Keck PE, Jr., McElroy SL, Altshuler LL, et al. Early-onset bipolar disorder and treatment delay are risk factors for poor outcome in adulthood. The Journal of Clinical Psychiatry. 2010;71(7):864- 72. https://doi.org/10.4088/jcp.08m04994yel
  13. Vohringer PA, Perlis RH. Discriminating between bipolar disorder and major depressive disorder. The Psychiatric Clinics of North America. 2016;39(1):1-10. https://doi.org/10.1016/j.psc.2015.10.001
  14. Dudek D, Siwek M, Zielińska D, Jaeschke R, Rybakowski J. Diagnostic conversions from major depressive disorder into bipolar disorder in an outpatient setting: results of a retrospective chart review. Journal of Affective Disorders. 2013 Jan 10;144(1-2):112-5. https://doi.org/10.1016/j.jad.2012.06.014
  15. Woo YS, Chae JH, Jun TY, Kim KS, Bahk WM. The bipolar diathesis of treatment-resistant major depressive disorder. International Journal of Psychiatry in Clinical Practice. 2008 Jan 1;12(2):142-6. https://doi.org/10.1080/13651500701749867
  16. Li CT, Bai YM, Huang YL, Chen YS, Chen TJ, Cheng JY, Su TP. Association between antidepressant resistance in unipolar depression and subsequent bipolar disorder: cohort study. The British Journal of Psychiatry. 2012 Jan;200(1):45-51. https://doi.org/10.1192/bjp.bp.110.086983
  17. Berk M, Malhi GS, Hallam K, Gama CS, Dodd S, Andreazza AC, Frey BN, Kapczinski F. Early intervention in bipolar disorders: clinical, biochemical and neuroimaging imperatives. Journal of Affective Disorders. 2009 Apr 1;114(1- 3):1-3. https://doi.org/10.1016/j.jad.2008.08.011
  18. Hirschfeld RM, Williams JB, Spitzer RL, Calabrese JR, Flynn L, Keck Jr PE, Lewis L, McElroy SL, Post RM, Rapport DJ, Russell JM. Development and validation of a screening instrument for bipolar spectrum disorder: the Mood Disorder Questionnaire. American Journal of Psychiatry. 2000 Nov 1;157(11):1873-5. https://doi.org/10.1176/appi.ajp.157.11.1873
  19. Angst J, Adolfsson R, Benazzi F, Gamma A, Hantouche E, Meyer TD, Skeppar P, Vieta E, Scott J. The HCL-32: towards a self-assessment tool for hypomanic symptoms in outpatients. Journal of Affective Disorders. 2005 Oct 1;88(2):217-33. https://doi.org/10.1016/j.jad.2005.05.011
  20. Goodwin GO, Consensus Group of the British Association for Psychopharmacology. Evidence-based guidelines for treating bipolar disorder: revised second edition - recommendations from the British Association for Psychopharmacology. Journal of Psychopharmacology. 2009 Jun;23(4):346-88. https://doi.org/10.1177/0269881109102919
  21. Yatham LN, Kennedy SH, Parikh SV, Schaffer A, Beaulieu S, Alda M, O’Donovan C, MacQueen G, McIntyre RS, Sharma V, Ravindran A. Canadian Network for Mood and Anxiety Treatments (CANMAT) and International Society for Bipolar Disorders (ISBD) collaborative update of CANMAT guidelines for the management of patients with bipolar disorder: update 2013. Bipolar Disorders. 2013 Feb;15(1):1-44. https://doi.org/10.1111/bdi.12025
  22. Miziou S, Tsitsipa E, Moysidou S, Karavelas V, Dimelis D, Polyzoidou V, Fountoulakis KN. Psychosocial treatment and interventions for bipolar disorder: a systematic review. Annals of General Psychiatry. 2015 Dec;14(1):19. https://doi.org/10.1186/s12991-015-0057-z
  23. McIntyre RS, Filteau MJ, Martin L, Patry S, Carvalho A, Cha DS, Barakat M, Miguelez M. Treatment-resistant depression: definitions, review of the evidence, and algorithmic approach. Journal of Affective Disorders. 2014 Mar 1;156:1-7. https://doi.org/10.1016/j.jad.2013.10.043
  24. Rios AC, Noto MN, Rizzo LB, Mansur R, Martins Jr FE, Grassi-Oliveira R, Correll CU, Brietzke E. Early stages of bipolar disorder: characterization and strategies for early intervention. Revista Brasileira de Psiquiatria. 2015 Dec;37(4):343-9. https://doi.org/10.1590/1516-4446-2014-1620