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. 2019 Sep 30:18:23.
doi: 10.1186/s12991-019-0248-0. eCollection 2019.

All-cause mortality in patients with treatment-resistant depression: a cohort study in the US population

Gang Li  1 , Daniel Fife  2 , Grace Wang  1 , John J Sheehan  3 , Robert Bodén  4   5 , Lena Brandt  5 , Philip Brenner  5 , Johan Reutfors  5 , Allitia DiBernardo  1
Affiliations

All-cause mortality in patients with treatment-resistant depression: a cohort study in the US population

Gang Li et al. Ann Gen Psychiatry. .

Abstract

Background: Treatment-resistant depression (TRD) may represent a substantial proportion of major depressive disorder (MDD); however, the risk of mortality in TRD is still incompletely assessed.

Methods: Data were obtained from Optum Clinformatics™ Extended, a US claims database. Date of the first antidepressant (AD) dispensing was designated as the index date for study entry and 6 months prior to that was considered the baseline period. Patients with MDD aged ≥ 18 years, index date between January 1, 2008 and September 30, 2015, no AD claims during baseline, and continuous enrollment in the database during baseline were included. Patients who started a third AD regimen after two regimens of appropriate duration were included in the TRD cohort. All-cause mortality was compared between patients with TRD and non-TRD MDD using a proportional hazards model and Kaplan-Meier estimate with TRD status being treated as a time-varying covariate. The model was adjusted for study year, age, gender, depression diagnosis, substance use disorder, psychiatric comorbidities, and Charlson comorbidity index.

Results: Out of 355,942 patients with MDD, 34,176 (9.6%) met the criterion for TRD. TRD was associated with a significantly higher mortality compared with non-TRD MDD (adjusted HR: 1.29; 95% CI 1.22-1.38; p < 0.0001). Survival time was significantly shorter in the TRD cohort compared with the non-TRD MDD cohort (p < 0.0001).

Conclusions: Patients with TRD had a higher all-cause mortality compared with non-TRD MDD patients.

Keywords: Major depressive disorder; Mortality; Treatment-resistant depression.

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Conflict of interest statement

Competing interestsGL, DF, GW, CB, JS, and AD are employees of Janssen Research & Development, LLC and hold stocks in the parent company. LB, PB, RB, and JR are in research collaboration with Janssen for which grant support has been received by Karolinska Institutet. JR has conducted research in collaboration with Abbvie, AstraZeneca, and Pfizer, for which grant/research support has been received by Karolinska Institutet.

Figures

Fig. 1
Fig. 1
Study design. AD antidepressant, MDD major depressive disorder, Rx prescription, Dx diagnosis
Fig. 2
Fig. 2
Kaplan–Meier plot. aDay 0 was the first antidepressant dispensing day for non-TRD MDD and the TRD onset date for TRD patients
See this image and copyright information in PMC

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