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Additional treatment rare 2 years after initial MDD diagnosis

Recent findings indicated significant heterogeneity in course trajectories of moderate-to-severe major depressive disorder, with many individuals not receiving additional treatment 2 years after diagnosis.

“Characterizing heterogeneity in long-term [major depressive disorder (MDD)] course trajectories is important for several reasons,” Katherine L. Musliner, PhD, of Aarhus University, Denmark, and colleagues wrote. “First, individuals who follow different trajectories likely have different treatment needs. Second, differences in the patterns of long-term course may indicate differences in the underlying causes of depressive symptoms. Parsing the heterogeneity in the course of depression and identifying factors associated with different course trajectories have the potential to change how we understand and treat depression, and ultimately could improve our ability to intervene effectively and rationally to prevent or mitigate this disorder.”

To characterize patterns and correlates of 10-year course trajectories of MDD, researchers assessed data for 11,640 individuals with their first recorded MDD diagnosis in the Danish Psychiatric Central Research Register between 1995 and 2002. Participants were followed for 10 years from the date of initial MDD diagnosis. Mean age at diagnosis was 31.4 years.

Researchers identified four trajectory classes:

• brief contact (77%), characterized by probability of contact after 2 years;
• prolonged initial contact (12.8%), characterized by high decreasing probability of contact during first 5 years;
• later reentry (7.1%), characterized by moderate probability of contact during the second 5 years; and
• persistent contact (3.1%), characterized by high or moderate probability of contact throughout.

Female sex (OR range = 1.82-2.22), inpatient treatment (OR range = 1.4-1.5) and severity at initial MDD episode were associated with more severe trajectories.

Parental anxiety was associated with prolonged initial contact (OR = 1.34; 95% CI, 1.1-1.63), while parental depression was associated with later reentry (OR = 1.63; 95% CI, 1.28-2.09).

Parental schizophrenia was associated with the persistent contact trajectory (OR range = 2.55-3.04).

“It is time to realize the promise of personalized medicine in psychiatry,” Richard C. Shelton, MD, of the University of Alabama at Birmingham, wrote in an accompanying editorial. “Ideally, we should be able to bypass treatments that are less likely to be effective and start with those with a higher probability of success. Although currently available pharmacogenomic testing is a step in that direction, there are nongenetic factors that could be combined with genetic information to produce a composite algorithm. The further development of prediction algorithms holds the promise of early identification and intervention programs for people who are at the highest risk of chronic illness.” – by Amanda Oldt

Disclosure: Musliner and colleagues report no relevant financial disclosures. Shelton reports having served as a paid consultant for Allergan (Forest Pharmaceuticals), Bristol-Myers Squibb Company, Cerecor Inc, Clintara LLC, Forest Pharmaceuticals, Janssen Pharmaceutica, Medtronic Inc, MSI Methylation Sciences Inc, Naurex Inc, Nestlé Health (Pamlab Inc), Pfizer Inc, Ridge Diagnostics, Shire Plc, and Takeda Pharmaceuticals. He also reports receiving grant support from Alkermes Inc, Allergan (Forest Pharmaceuticals), Assurex Health, Avanir Pharmaceuticals, Cerecor Inc, Genomind, Janssen Pharmaceutica, Naurex Inc, Nestlé Health (Pamlab Inc), Novartis Inc, Otsuka Pharmaceuticals, and Takeda Pharmaceuticals.