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Treatment resistance in severe unipolar depression: No association with psychotic or melancholic features

Leonardo Zaninotto, MD

Institute of Psychiatry, University of Bologna, Bologna, Italy, Department of Psychiatry, Catholic University of Sacred Heart, Rome, Italy

Daniel Souery, MD

Laboratoire de Psychologie Medicale, Université Libre de Bruxelles, Brussels, Belgium, Psy Pluriel, Centre Européen de Psychologie Medicale, Brussels, Belgium

Raffaella Calati, PsyD, PhD

I.R.C.C.S. Centro San Giovanni di Dio, Fatebenefratelli, Brescia, Italy

Othman Sentissi, MD, PhD

Département de Psychiatrie, Hôpitaux Universitaires de Genève, Faculté de Médecine de Genève, Geneva, Switzerland

Siegfried Kasper, MD

Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria

Elena Akimova, MD

Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria

Joseph Zohar, MD

Chaim Sheba Medical Center, Tel-Hashomer, Israel

Stuart Montgomery, MD

Imperial College School of Medicine, London, United Kingdom

Julien Mendlewicz, MD, PhD

Université Libre de Bruxelles, Brussels, Belgium

Alessandro Serretti, MD, PhD

Institute of Psychiatry, University of Bologna, Bologna, Italy

BACKGROUND: Depressive subtypes generally have been neglected in research on treatment efficacy. We studied a sample of 699 severe unipolar depressed patients to detect any association between depressive features and treatment resistance.

METHODS: Participants were divided into psychotic (PSY, n = 90), melancholic (MEL, n = 430) and non-melancholic (n = 179) subjects according to clinical features. Formal diagnostic criteria (Mini International Neuropsychiatric Interview items), and items from 17-item Hamilton Rating Scale for Depression (HRSD17) were compared across groups. Non-responders were defined by a HRSD17 cut-off score of ≥17 after the last adequate antidepressant treatment. Treatment-resistant depression (TRD) was defined as the failure to respond to ≥2 adequate antidepressant trials. Non-linear regression models were designed to detect associations between depressive subtypes and TRD.

RESULTS: PSY and MEL patients appeared to be more severely affected and to share some “core” melancholic symptoms. Both PSY and MEL patients reported a higher rate of seasonality. However, we found no clinical or illness course variable associated with TRD.

CONCLUSIONS: Our results indicate that psychotic and melancholic depression share some “core” melancholia symptoms, while no distinguishing psychopathological feature appears to be associated with TRD in severely depressed patients.

KEYWORDS: major depression, antidepressant, resistant, psychotic, melancholic


CORRESPONDENCE: Alessandro Serretti, MD, PhD Institute of Psychiatry University of Bologna Viale Carlo Pepoli 5 40123 Bologna, Italy E-MAIL:
Annals of Clinical Psychiatry ©2013 Frontline Medical Communications Inc.

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