New research presented today at the American Psychiatric Association’s Annual Meeting in San Francisco evaluated how accurately a self-reporting tool predicts difficult-to-treat depression, finding that the Difficult-to-Treat Depression Questionnaire (DTDQ) helps identify patients with a lower probability of depression remission before they experience treatment failures.
The study sampled 211 patients with major depressive disorder, each of whom completed a Remission from Depression questionnaire and the DTDQ. The Remission from Depression questionnaire assessed depressive symptoms, non-depressive symptoms, coping ability, positive mental health, functional impairment, and quality of life, whereas the DTDQ assessed factors predicting poor outcomes in depression.
The study authors included Mark Zimmerman, M.D., and Daniel M. Mackin, M.A., of South County Psychiatry, Behavioral Health, in North Kingstown, Rhode Island. They analyzed the correlations between DTDQ and the Remission from Depression questionnaire at admission and discharge from a partial hospital program.
The correlation between the two questionnaires decreased between admission and discharge for each factor analyzed in the study (depressive symptoms, coping ability, etc.). The DTDQ predicted greater total RDQ scores, greater symptom severity, poorer coping, greater functional impairment, and lower quality of life at discharge—even after controlling for baseline severity.
Importantly, the DTDQ predicted treatment outcomes in depressed patients without the occurrence of multiple treatment failures. Unlike treatment-resistant depression classification, the DTDQ provides early prognostic information, which enables the earlier identification of high-risk patients. Thus, identifying difficult-to-treat depression may invite a shift in the main goal of treatment from symptom elimination to improved quality of life, and the use of a standardized, quantifiable measure of DTD could address concerns about manipulating the criteria for patient recruitment into treatment studies of DTD.
“These findings suggest that patients with difficult-to-treat depression may no longer be subject to repeated medication trials in order to receive the specialized care they need,” said Zimmerman. “The DTDQ expands on our traditional understanding of treatment-resistant depression, incorporating psychosocial and illness-related risk factors into the existing framework and opening the door to a new perception of treating and coping with depression.”
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