うつ病の半数近くが治療抵抗性と考えられる(Nearly half of depression diagnoses could be considered treatment-resistant)

ad

2025-03-21 バーミンガム大学

バーミンガム大学とバーミンガム・ソリフル精神保健NHS財団信託の研究者らは、うつ病と診断された患者の約48%が少なくとも2種類の抗うつ薬を試みても効果が見られない「治療抵抗性うつ病(TRD)」に分類されることを明らかにしました。 さらに、37%の患者は4種類以上の抗うつ薬を試していました。TRDの患者は、他の精神疾患(不安障害、自己傷害、パーソナリティ障害)や心疾患のリスクが高まることも示されています。研究者らは、TRD患者に対する治療法の改善と、個別化されたケアの必要性を強調しています。

<関連情報>

治療抵抗性うつ病患者2461人のニーズ、転帰、現在の治療経路を検証する:混合方法研究 Examining the needs, outcomes and current treatment pathways of 2461 people with treatment-resistant depression: mixed-methods study

Kiranpreet Gill,Danielle Hett,Max Carlish,Rebekah Amos,Ali Khatibi,Isabel Morales-Muñoz andSteven Marwaha
The British Journal of Psychiatry  Published:12 March 2025
DOI:https://doi.org/10.1192/bjp.2024.275

Abstract

Background
A substantial subset of patients with major depressive disorder (MDD) experience treatment-resistant depression (TRD), typically defined as failure to respond to at least two sequential antidepressant trials at adequate dose and length.

Aims
To examine clinical and service-level associations of TRD, and the experiences of people with TRD and clinicians involved in their care within a large, diverse National Health Service trust in the UK.

Method
This mixed-methods study integrated quantitative analysis of electronic health records with thematic analysis of semi-structured interviews. Chi-squared tests and one-way analysis of variance were used to assess associations between lines of antidepressant treatments and sociodemographic and clinical variables, and binary logistic regression was used to identify associations of TRD status.

Results
Nearly half (48%) of MDD patients met TRD criteria, with 36.9% having trialled ≥4 antidepressant treatments. People with TRD had higher rates of recurrent depression (odds ratio = 1.24, 95% CI: 1.05–1.45, P = 0.008), comorbid anxiety disorders (odds ratio = 1.21, 95% CI: 1.03–1.41, P = 0.019), personality disorders (odds ratio=1.35, 95% CI: 1.10–1.65, P = 0.003), self-harm (odds ratio = 1.76, 95% CI: 1.06–2.93, P = 0.029) and cardiovascular diseases (odds ratio = 1.46, 95% CI: 1.02–2.07, P = 0.0374). Greater treatment resistance was linked to increased economic inactivity and functional loss. Qualitative findings revealed severe emotional distress and frustration with existing treatments, as well as organisational and illness-related barriers to effective care.

Conclusions
TRD is characterised by increasing mental and physical morbidity and functional decline, with individuals experiencing barriers to effective care. Improved pathways, service structures and more effective biological and psychological interventions are needed.

医療・健康
ad
ad
Follow
ad
タイトルとURLをコピーしました