Zaburzenie depresyjne nawracające (depresja jednobiegunowa)
Rokowania, prognozy i postęp choroby

Zaburzenie depresyjne nawracające (depresja jednobiegunowa) jest czwartą wiodącą przyczyną niepełnosprawności globalnie, z przewidywaniami, że do 2030 roku stanie się główną przyczyną obciążenia chorobowego. Około 5% dorosłej populacji, czyli około 300 milionów osób, cierpi na to schorzenie. Rokowanie jest złożone i zależy od czynników klinicznych, psychospołecznych i biologicznych. Mediana czasu trwania epizodu wynosi około 23 tygodni, z najwyższą poprawą w pierwszych 3 miesiącach. W populacji ogólnej około 50% pacjentów wraca do zdrowia, jednak przy uwzględnieniu zaburzeń afektywnych i lękowych wskaźnik remisji spada do 17%, a przewlekłe nawroty dotyczą 55% pacjentów. Kluczowe czynniki pogarszające rokowanie to m.in. ciężkie objawy początkowe, wczesny wiek zachorowania, wcześniejsze epizody, niepełna remisja po roku leczenia oraz choroby współistniejące, zwłaszcza zaburzenia lękowe, które obniżają skuteczność terapii SSRI i innych strategii drugiego rzutu.

  1. Rokowanie i przewidywanie wyników leczenia zaburzenia depresyjnego nawracającego (depresji jednobiegunowej)
    1. Ogólne rokowanie i przebieg choroby
    2. Czynniki wpływające na rokowanie
    3. Przewidywanie odpowiedzi na leczenie
    4. Biomarkery i nowoczesne metody przewidywania odpowiedzi na leczenie
    5. Depresja oporna na leczenie
    6. Modele prognostyczne i medycyna precyzyjna
  2. Czynniki indywidualne wpływające na rokowanie w depresji
    1. Odporność jako czynnik rokowniczy
  3. Podsumowanie aktualnych perspektyw rokowniczych
    1. Kolejne rozdziały

Rokowanie i przewidywanie wyników leczenia zaburzenia depresyjnego nawracającego (depresji jednobiegunowej)

Zaburzenie depresyjne nawracające (depresja jednobiegunowa) stanowi jedno z najpoważniejszych wyzwań współczesnej psychiatrii, będąc czwartą wiodącą przyczyną niepełnosprawności na świecie według Światowej Organizacji Zdrowia. Przewiduje się, że do 2030 roku zajmie pierwsze miejsce pod względem obciążenia chorobowego. Około 300 milionów ludzi na świecie cierpi na to zaburzenie, w tym 5% dorosłej populacji.12 Rokowanie w zaburzeniu depresyjnym nawracającym jest złożone i zależy od wielu czynników: klinicznych, psychospołecznych i biologicznych.

Ogólne rokowanie i przebieg choroby

Długoterminowe badania obserwacyjne dostarczają istotnych informacji na temat naturalnego przebiegu zaburzenia depresyjnego nawracającego. Badania wskazują, że 80% osób z pierwszym epizodem depresji doświadczy przynajmniej jednego kolejnego epizodu w ciągu życia, ze średnią życiową liczbą czterech epizodów.3 W populacji ogólnej około połowa osób, które doświadczyły epizodu depresji, wraca do zdrowia (niezależnie od tego, czy byli leczeni czy nie), podczas gdy druga połowa doświadczy co najmniej jednego kolejnego epizodu, a około 15% z nich będzie miało przewlekłe nawroty.4

Należy jednak zauważyć, że te optymistyczne wskaźniki mogą nie odzwierciedlać pełnego obrazu rokowania. Badania z dłuższym, 6-letnim okresem obserwacji, włączające zarówno zaburzenia afektywne jak i lękowe, wskazują na znacznie mniej korzystne rokowanie. Przy zastosowaniu szerszej perspektywy (uwzględniającej zaburzenia afektywne i lękowe) wskaźnik powrotu do zdrowia spadł do zaledwie 17%, a odsetek pacjentów z przewlekłymi epizodami wzrósł do 55%.5 Sugeruje to, że konceptualizowanie i leczenie zaburzenia depresyjnego jako wąsko zdefiniowanego i epizodycznego schorzenia może prowadzić do niedoszacowania jego rzeczywistego rokowania.6

Mediana czasu trwania epizodu depresyjnego została oszacowana na 23 tygodnie, przy czym najwyższy wskaźnik poprawy obserwuje się w pierwszych trzech miesiącach.7 Według przeglądu z 2013 roku, 23% nieleczonych dorosłych z łagodną do umiarkowanej depresją osiągnie remisję w ciągu 3 miesięcy, 32% w ciągu 6 miesięcy, a 53% w ciągu 12 miesięcy.8

Czynniki wpływające na rokowanie

Wyróżnia się kilka kluczowych czynników związanych z gorszym rokowaniem w depresji:9

  • Nieodpowiednie leczenie
  • Ciężkie początkowe objawy, w tym objawy psychotyczne
  • Wczesny wiek zachorowania
  • Wcześniejsze epizody
  • Niepełna remisja po roku leczenia
  • Wcześniej istniejące ciężkie zaburzenia psychiczne lub schorzenia medyczne
  • Dysfunkcja rodzinna

9

Istotnym czynnikiem rokowniczym jest czas trwania nieleczonej depresji. Badania jednoznacznie wykazują odwrotną zależność między czasem trwania epizodu a wynikiem leczenia (zarówno w odniesieniu do odpowiedzi jak i remisji). Krótszy czas trwania nieleczonej choroby, zarówno w przypadku pierwszego, jak i nawracających epizodów, jest czynnikiem prognostycznym wskazującym na lepszą odpowiedź na leczenie i lepsze długoterminowe wyniki.1011

Obecność chorób współistniejących znacząco wpływa na przebieg i rokowanie zaburzenia depresyjnego. Współwystępowanie zaburzeń psychicznych, szczególnie lękowych, koreluje z gorszą odpowiedzią na leczenie przeciwdepresyjne.12 Podwyższony poziom lęku na początku leczenia lub współistniejące zaburzenia lękowe są związane z gorszą odpowiedzią na leki z grupy selektywnych inhibitorów zwrotnego wychwytu serotoniny (SSRI) lub strategie leczenia drugiego rzutu.13

Badania wykazały również, że tylko wyższy poziom lęku somatycznego był związany z gorszą remisją, nawet po uwzględnieniu współzmiennych i wielokrotnych porównań.14 Sugeruje to, że objawy lękowe u osób z zaburzeniem depresyjnym nawracającym można podzielić na odrębne czynniki, które różnie reagują na leczenie.15

Zaburzenie depresyjne nawracające i kilka chorób somatycznych, w tym choroby sercowo-naczyniowe i cukrzyca, wydają się mieć dwukierunkowy wpływ na przebieg choroby.16 Osoby cierpiące na depresję mają krótszą oczekiwaną długość życia niż osoby bez depresji, częściowo dlatego, że są narażone na ryzyko popełnienia samobójstwa.17 Około 2-8% dorosłych z ciężką depresją umiera w wyniku samobójstwa.18

Istnieje również 1,5- do 2-krotnie zwiększone ryzyko chorób sercowo-naczyniowych, niezależnie od innych znanych czynników ryzyka.19 Wpływ depresji na społeczeństwo i gospodarkę jest zwiększony przez istnienie chorób współistniejących. W 2018 roku w Stanach Zjednoczonych zaburzenia współistniejące, a nie samo zaburzenie depresyjne, odpowiadały za 63% wszystkich kosztów związanych z depresją.20

Przewidywanie odpowiedzi na leczenie

Jednym z najważniejszych predyktorów odpowiedzi na leczenie przeciwdepresyjne jest wczesna poprawa. Nowe dowody wskazują, że odpowiedź na leczenie można przewidzieć z wysoką czułością już po 2 tygodniach leczenia.21 Wczesna poprawa przewidywała stabilną odpowiedź i stabilną remisję z wysoką czułością (odpowiednio 81% i 87%).22 Wyniki te wskazują, że wczesna poprawa po zastosowaniu leków przeciwdepresyjnych może przewidzieć późniejszy wynik leczenia z wysoką czułością u pacjentów z zaburzeniem depresyjnym nawracającym.23

Brak poprawy w ciągu pierwszych 2 tygodni terapii może wskazywać na konieczność rozważenia zmian w leczeniu depresji wcześniej niż konwencjonalnie się uważa.24 Wczesna odpowiedź na leczenie przeciwdepresyjne wydaje się występować niezależnie od modalności leczenia czy parametrów wynikowych.25

Niższa funkcja wyjściowa i jakość życia, w tym dłuższy czas trwania bieżącego epizodu indeksowego, wiązały się z niższymi wskaźnikami remisji po różnych rodzajach leczenia przeciwdepresyjnego.26 Gorsze wyniki u pacjentów z cięższą chorobą na początku leczenia były również zgłaszane u pacjentów w podeszłym wieku leczonych w ramach podstawowej opieki zdrowotnej.27

Biomarkery i nowoczesne metody przewidywania odpowiedzi na leczenie

Badania nad biomarkerami w depresji rozwijają się bardzo dynamicznie. Spójne z procesami neurozapalnymi podwyższone poziomy białka C-reaktywnego (CRP), czynnika martwicy nowotworu alfa (TNF) i interleukiny-6 (IL-6) zostały zgłoszone u części pacjentów z zaburzeniem depresyjnym nawracającym.2829

Badanie longitudinalne wykazało, że niższe poziomy CRP były związane z szybszą odpowiedzią na SSRI, związek ten nie był obserwowany w przypadku terapii kombinowanej SSRI-bupropion.30 Przekonujące dowody sugerują, że poziomy czynnika neurotroficznego pochodzenia mózgowego (BDNF) są obniżone na początku leczenia u pacjentów z depresją i podniesione w odpowiedzi na leczenie farmakologiczne oraz elektrowstrząsowe.31

Markery strukturalne odpowiedzi na leczenie przeciwdepresyjne sugerują, że objętość hipokampa jest związana z odpowiedzią i remisją.32 Objętość innych regionów mózgu, w tym kory przedniej części zakrętu obręczy lub kory oczodołowo-czołowej, również wykazano jako zmniejszoną u osób z zaburzeniem depresyjnym nawracającym, ale potrzebne są bardziej długoterminowe badania neuroobrazowe z lekami przeciwdepresyjnymi, aby wyjaśnić to powiązanie.33

Zaawansowane metody, takie jak uczenie maszynowe i analiza danych z obrazowania mózgu, oferują obiecujące podejście do przewidywania wyników leczenia. Analiza machine learning elektroencefalogramu (EEG) może przewidzieć wynik leczenia przeciwdepresyjnego z dokładnością około 74%.34 W szczególności, cechy fal delta i theta mogą być obiecującym narzędziem do przewidywania działania terapeutycznego w leczeniu SSRI.35

Badania wykazały również, że analiza uczenia maszynowego danych z rezonansu magnetycznego (MRI) może przewidzieć sukces leczenia przeciwdepresyjnego z AUC 0,84, czułością 77% i swoistością 79%.36 Chociaż terapia elektrowstrząsowa (ECT) wykazała nieco wyższą czułość i swoistość, przedziały ufności w dużej mierze nakładały się między dwoma typami interwencji.37

Funkcjonalne połączenia spoczynkowe (rsFC) w obrębie sieci trybu domyślnego (DMN) miały małą, ale znaczącą zdolność predykcyjną odpowiedzi na leczenie w zaburzeniu depresyjnym nawracającym.38 Połączone dowody sugerują, że podstawowe rsFC w obrębie DMN i między DMN a siecią czołowo-ciemieniową (FPN) miały małą i zróżnicowaną zdolność przewidywania wyniku odpowiednio leków przeciwdepresyjnych i nieinwazyjnej stymulacji mózgu.39

Depresja oporna na leczenie

Depresja oporna na leczenie (TRD) odnosi się do braku odpowiedzi na odpowiednie próby leków lub innych metod leczenia przeciwdepresyjnego. Badania sugerują, że 30-50% pacjentów z zaburzeniem depresyjnym nawracającym nie reaguje na początkowe próby leczenia przeciwdepresyjnego, a około 20% pozostaje w depresji do 2 lat po wystąpieniu.40

Dane przekrojowe z badania GSRD zidentyfikowały szereg czynników ryzyka związanych z TRD, w tym choroby współistniejące, ryzyko samobójstwa, nasilenie epizodu, liczbę hospitalizacji, nawroty epizodów, wczesny początek, cechy melancholiczne i brak odpowiedzi na pierwsze leczenie.41 Łącznie dowody wskazują, że pacjenci z TRD wymagają szczególnej uwagi, ponieważ wyniki u tych osób są znacznie gorsze.42

Badania pokazują również w jaki sposób stresujące wydarzenia życiowe, a także choroby współistniejące fizyczne i psychiatryczne, przyczyniają się do pogorszenia wyników.43 Te czynniki przyczyniają się do oporności na leczenie, która zyskała znaczną wagę jako zmienna stratyfikująca pacjentów.44

Modele prognostyczne i medycyna precyzyjna

Pomimo postępów w badaniach nad biomarkerami i metodami przewidywania odpowiedzi na leczenie, obecnie dostępne kliniczne modele predykcyjne nawrotu i nawrotu depresji nie są jeszcze wystarczająco rozwinięte do wdrożenia w warunkach klinicznych.45

Wiarygodne przewidywanie indywidualnego ryzyka nawrotu i nawrotu mogłoby umożliwić podejście medycyny precyzyjnej do zapobiegania nawrotom, personalizując alokację i potencjalnie rodzaj oferowanych interwencji zapobiegających nawrotom, aby zapewnić maksymalne korzyści.46

Projekt OPADE oceni wzajemne oddziaływanie między czynnikami genetycznymi, epigenetycznymi, środowiskowymi i zapalnymi w celu usprawnienia podejmowania decyzji dotyczących oceny, dokładnej diagnozy i odpowiedniego leczenia, z uwzględnieniem możliwych alternatywnych odpowiedzi pacjenta, obserwacji wyników i odpowiedniego dostosowania procesów.47

Algorytmy uczenia maszynowego oferują znaczącą pomoc w diagnozowaniu i prognozowaniu zaburzenia depresyjnego, pomimo jego jednolitej obecności wśród badanych. Algorytmy te wykonują kilka kluczowych funkcji: podtypy depresji lub ocena jej nasilenia przy użyciu cech takich jak profile objawów i biomarkery, umożliwiające dostosowane strategie leczenia. Przewidują odpowiedzi na leczenie w oparciu o profile genetyczne i dane kliniczne, oferując spersonalizowane plany.48

Czynniki indywidualne wpływające na rokowanie w depresji

Rokowanie choroby jest zwykle bardzo związane z obecnością czynników wyzwalających. Gdy zaburzenie depresyjne pojawia się całkowicie spontanicznie, rokowanie jest zwykle lepsze. Z drugiej strony, gdy jest związane z jakimś zdarzeniem wyzwalającym lub z cechami osobowości pacjenta, zwykle ma tendencję do przewlekłości (lub innymi słowy, słabą odpowiedź na leczenie).49

Głównym długoterminowym powikłaniem zaburzeń depresyjnych, szczególnie w podtypach dystymii i ciężkiej depresji, jest zwiększona tendencja do nawrotów. Nie można przewidzieć, u kogo wystąpi nawracający przebieg, a u kogo nie. Jednak istnieją pewne zmienne, które są związane z większą lub mniejszą tendencją do występowania nowych epizodów.50

Trzeba pamiętać, że zaburzenia depresyjne mogą mieć wyzwalacz (na przykład stresującą sytuację środowiskową) lub mogą być pozornie spontaniczne. Dlatego ważne jest, aby podkreślić, że bardzo charakterystyczne dla zaburzeń depresyjnych jest to, że im większa liczba wcześniejszych epizodów, tym większa autonomia zaburzenia; to znaczy, że im więcej wcześniejszych epizodów, tym bardziej prawdopodobne jest, że następny epizod może nie mieć zewnętrznego wyzwalacza.51

Odporność jako czynnik rokowniczy

Badania wykazały interesującą zależność między odpornością pacjenta a wynikiem leczenia. Odporność pacjentów hospitalizowanych (mierzona za pomocą Skali Odporności, wersja 11-elementowa (RS-11)) była negatywnie związana z powodzeniem 5-tygodniowego leczenia zaburzenia depresyjnego nawracającego.52

Ta relacja była w pełni mediowana przez subiektywne nasilenie depresji pacjentów na początku badania. Pacjenci, którzy czuli się bardziej ciężko dotknięci depresją na początku, doświadczyli najlepszego powodzenia leczenia w punkcie końcowym badania, co było zgodne z wcześniejszymi badaniami.53

Chociaż potwierdza to reputację odporności jako czynnika ochronnego dla depresji, okazało się, że odporność jest (słabym) negatywnym predyktorem powodzenia leczenia szpitalnego zaburzenia depresyjnego nawracającego.54

Podsumowanie aktualnych perspektyw rokowniczych

Mimo postępów w leczeniu, wyniki dla zaburzenia depresyjnego nawracającego (depresji jednobiegunowej) muszą zostać poprawione. Obecnie nie ustalono klinicznie istotnych narzędzi do stratyfikacji podgrup lub przewidywania wyników.55

Wyniki badań pokazują, że wczesne rozpoznanie i leczenie są kluczowe, ponieważ czas trwania nieleczonej depresji koreluje z gorszymi wynikami. Wczesna poprawa jest związana z odpowiedzią i remisją, podczas gdy choroby współistniejące przedłużają przebieg choroby.56

Wpływ czynników socjodemograficznych, takich jak wiek, wiek wystąpienia, płeć i liczba poprzednich epizodów, na wynik leczenia był badany z mieszanymi rezultatami.57 Wysokie poziomy stresu znacząco wpływają na wyniki u pacjentów z zaburzeniem depresyjnym, którzy są podatni na stany wrażliwości, takie jak osoby z wysokim poziomem neurotyczności.58

Najnowsze badania doprowadziły do ważnych spostrzeżeń dotyczących neurobiologicznych markerów choroby, które mogą prowadzić do poprawy stratyfikacji choroby i przewidywania odpowiedzi w niedalekiej przyszłości.59 Kluczowe odkrycia dotyczące nowych substancji o szybkim działaniu, w połączeniu z ulepszeniami technik stymulacji mózgu, mogą również skutkować znaczną poprawą wyników leczenia u wcześniej trudnych do leczenia pacjentów.60

Kolejne rozdziały

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  1. 10.04.2026
  2. www.leksykon.com.pl

Materiały źródłowe

  • #1 Major depressive disorder: hypothesis, mechanism, prevention and treatment | Signal Transduction and Targeted Therapy
    https://www.nature.com/articles/s41392-024-01738-y
    Worldwide, the incidence of major depressive disorder (MDD) is increasing annually, resulting in greater economic and social burdens. […] The prevalence of depression is increasing yearly. About 300 million people in the world are affected by MDD, which has become one of the main causes of disability. […] In 2018, MDD ranked third in terms of disease burden according to the WHO, and it is predicted to rank first by 2030. […] Pharmacological therapies for MDD can effectively control symptoms; thus, patients may experience recurrence within a short time after discontinuing medication. […] During recurrence, the patient experiences symptoms of low mood, loss of interest in life, fatigue, delayed thinking, and repeated fluctuations in mental state. […] However, due to the lack of characteristic symptoms and objective diagnostic evidence for MDD, identification and early prevention are difficult in the clinic.
  • #2
    https://www.who.int/health-topics/depression
    Depressive disorder, or depression, is a common mental health condition that can happen to anyone. […] Depression results from a complex interaction of social, psychological and biological factors. […] In 2019, an estimated 280 million people, including 5% of all adults, experienced depression. […] Depression can cause difficulties in all aspects of life, including performance at school, productivity at work, relationships with family, friends and community. […] People with depression are at increased risk of suicide. […] WHO works with Member States and partners to reduce the burden of mental health conditions, including depression. […] Depression and self-harm/suicide are among the priority conditions covered by WHO’s Mental Health Gap Action Programme (mhGAP). […] WHO has developed brief psychological intervention manuals for depression that may be delivered by non-specialists to individuals and groups.
  • #3 Major depressive disorder – Wikipedia
    https://en.wikipedia.org/wiki/Major_depressive_disorder
    Studies have shown that 80% of those with a first major depressive episode will have at least one more during their life, with a lifetime average of four episodes. […] Other general population studies indicate that around half those who have an episode recover (whether treated or not) and remain well, while the other half will have at least one more, and around 15% of those experience chronic recurrence. […] Cases when outcome is poor are associated with inappropriate treatment, severe initial symptoms including psychosis, early age of onset, previous episodes, incomplete recovery after one year of treatment, pre-existing severe mental or medical disorder, and family dysfunction. […] A high proportion of people who experience full symptomatic remission still have at least one not fully resolved symptom after treatment.
  • #4 Major depressive disorder – Wikipedia
    https://en.wikipedia.org/wiki/Major_depressive_disorder
    Studies have shown that 80% of those with a first major depressive episode will have at least one more during their life, with a lifetime average of four episodes. […] Other general population studies indicate that around half those who have an episode recover (whether treated or not) and remain well, while the other half will have at least one more, and around 15% of those experience chronic recurrence. […] Cases when outcome is poor are associated with inappropriate treatment, severe initial symptoms including psychosis, early age of onset, previous episodes, incomplete recovery after one year of treatment, pre-existing severe mental or medical disorder, and family dysfunction. […] A high proportion of people who experience full symptomatic remission still have at least one not fully resolved symptom after treatment.
  • #5 Reconsidering the prognosis of major depressive disorder across diagnostic boundaries: full recovery is the exception rather than the rule | BMC Medicine | Full Text
    https://bmcmedicine.biomedcentral.com/articles/10.1186/s12916-017-0972-8
    Major depressive disorder (MDD) is often handled as an episodic and isolated disorder, resulting in an optimistic view about its prognosis. […] Results from a long and rigorous follow-up in a large cohort suggests that most MDD patients have an unfavourable prognosis. […] Conceptualising and handling MDD as a narrowly defined and episodic disorder may underestimate the prognosis of the majority of depressed patients and, consequently, the type of care that is appropriate. […] With a short, narrow perspective (2-year follow-up and MDD only), 58% of patients appeared recovered and only a minority (21%) had a chronic episode. […] With a long, broad perspective (6-year follow-up, including affective and anxiety disorders) the recovery rate decreased to 17% and the proportion of patients with chronic episodes increased to 55%.
  • #6 Reconsidering the prognosis of major depressive disorder across diagnostic boundaries: full recovery is the exception rather than the rule | BMC Medicine | Full Text
    https://bmcmedicine.biomedcentral.com/articles/10.1186/s12916-017-0972-8
    Our data suggest that we may need to reconsider the prognosis of patients with MDD. Including symptoms of closely related disorders, such as (hypo)mania and anxiety, shows that the majority of patients have a disabling and chronic affective disorder and that full recovery is the exception rather than the rule.
  • #7 Major depressive disorder – Wikipedia
    https://en.wikipedia.org/wiki/Major_depressive_disorder
    Current guidelines recommend continuing antidepressants for four to six months after remission to prevent relapse. […] Major depressive episodes often resolve over time, whether or not they are treated. […] The median duration of an episode has been estimated to be 23 weeks, with the highest rate of recovery in the first three months. […] According to a 2013 review, 23% of untreated adults with mild to moderate depression will remit within 3 months, 32% within 6 months and 53% within 12 months. […] Depression may affect people’s ability to work. […] Depressed individuals have a shorter life expectancy than those without depression, in part because people who are depressed are at risk of dying of suicide. […] About 50% of people who die of suicide have a mood disorder such as major depression, and the risk is especially high if a person has a marked sense of hopelessness or has both depression and borderline personality disorder.
  • #8 Major depressive disorder – Wikipedia
    https://en.wikipedia.org/wiki/Major_depressive_disorder
    Current guidelines recommend continuing antidepressants for four to six months after remission to prevent relapse. […] Major depressive episodes often resolve over time, whether or not they are treated. […] The median duration of an episode has been estimated to be 23 weeks, with the highest rate of recovery in the first three months. […] According to a 2013 review, 23% of untreated adults with mild to moderate depression will remit within 3 months, 32% within 6 months and 53% within 12 months. […] Depression may affect people’s ability to work. […] Depressed individuals have a shorter life expectancy than those without depression, in part because people who are depressed are at risk of dying of suicide. […] About 50% of people who die of suicide have a mood disorder such as major depression, and the risk is especially high if a person has a marked sense of hopelessness or has both depression and borderline personality disorder.
  • #9 Major depressive disorder – Wikipedia
    https://en.wikipedia.org/wiki/Major_depressive_disorder
    Studies have shown that 80% of those with a first major depressive episode will have at least one more during their life, with a lifetime average of four episodes. […] Other general population studies indicate that around half those who have an episode recover (whether treated or not) and remain well, while the other half will have at least one more, and around 15% of those experience chronic recurrence. […] Cases when outcome is poor are associated with inappropriate treatment, severe initial symptoms including psychosis, early age of onset, previous episodes, incomplete recovery after one year of treatment, pre-existing severe mental or medical disorder, and family dysfunction. […] A high proportion of people who experience full symptomatic remission still have at least one not fully resolved symptom after treatment.
  • #10 Prognosis and improved outcomes in major depression: a review
    https://pmc.ncbi.nlm.nih.gov/articles/PMC6447556/
    Treatment outcomes for major depressive disorder (MDD) need to be improved. Presently, no clinically relevant tools have been established for stratifying subgroups or predicting outcomes. […] The results show that early recognition and treatment are crucial, as duration of untreated depression correlates with worse outcomes. Early improvement is associated with response and remission, while comorbidities prolong course of illness. […] Clear evidence of an inverse relationship between duration of episode and treatment outcome (either response or remission) underscores the importance of early intervention in MDD. […] In particular, replicable prospective and retrospective studies indicate that shorter duration of untreated disease both in terms of first and recurrent episodes is a prognostic factor indicating better treatment response and better long-term outcomes.
  • #11 Prognosis and improved outcomes in major depression: a review | Translational Psychiatry
    https://www.nature.com/articles/s41398-019-0460-3
    Treatment outcomes for major depressive disorder (MDD) need to be improved. Presently, no clinically relevant tools have been established for stratifying subgroups or predicting outcomes. […] The results show that early recognition and treatment are crucial, as duration of untreated depression correlates with worse outcomes. Early improvement is associated with response and remission, while comorbidities prolong course of illness. […] Clear evidence of an inverse relationship between duration of episode and treatment outcome (either response or remission) underscores the importance of early intervention in MDD. […] In particular, replicable prospective and retrospective studies indicate that shorter duration of untreated disease both in terms of first and recurrent episodes is a prognostic factor indicating better treatment response and better long-term outcomes.
  • #12 Prognosis and improved outcomes in major depression: a review | Translational Psychiatry
    https://www.nature.com/articles/s41398-019-0460-3
    Studies have found that elevated baseline anxiety symptoms or comorbid anxiety disorder are associated with worse antidepressant response to first-line selective serotonin reuptake inhibitors (SSRIs) or second-line treatment strategies. […] The connection appears to be relevant at any stage of the disease, as number of physical comorbidities did not separate TRD from non-TRD patients. […] The volume of other brain regions, including the anterior cingulate or orbitofrontal cortices, have also been shown to be decreased in MDD subjects, but more longitudinal neuroimaging trials with antidepressants are needed to clarify this association. […] Elevated levels of C-reactive protein (CRP), tumor necrosis factor alpha (TNF), and interleukin-6 (IL-6) have been reported in a subset of MDD patients.
  • #13 Prognosis and improved outcomes in major depression: a review | Translational Psychiatry
    https://www.nature.com/articles/s41398-019-0460-3
    Studies have found that elevated baseline anxiety symptoms or comorbid anxiety disorder are associated with worse antidepressant response to first-line selective serotonin reuptake inhibitors (SSRIs) or second-line treatment strategies. […] The connection appears to be relevant at any stage of the disease, as number of physical comorbidities did not separate TRD from non-TRD patients. […] The volume of other brain regions, including the anterior cingulate or orbitofrontal cortices, have also been shown to be decreased in MDD subjects, but more longitudinal neuroimaging trials with antidepressants are needed to clarify this association. […] Elevated levels of C-reactive protein (CRP), tumor necrosis factor alpha (TNF), and interleukin-6 (IL-6) have been reported in a subset of MDD patients.
  • #14 Dimensions of anxiety in Major depressive disorder and their use in predicting antidepressant treatment outcome: an iSPOT-D report | Psychological Medicine | Cambridge Core
    https://www.cambridge.org/core/journals/psychological-medicine/article/dimensions-of-anxiety-in-major-depressive-disorder-and-their-use-in-predicting-antidepressant-treatment-outcome-an-ispotd-report/C8325C17AD12A83851CD78DB9E1AD770
    Major depressive disorder (MDD) commonly co-occurs with clinically significant levels of anxiety. […] We aimed to identify and characterise dimensions of anxiety in people with MDD and their use in predicting antidepressant treatment outcome. […] Furthermore, only higher somatic anxiety was associated with poorer QIDS-SR16 remission, even after adjusting for covariates and multiple comparisons. […] Anxiety symptoms in people with MDD can be separated onto distinct factors that differentially respond to treatment outcome. […] Future research should consider cognitive and somatic symptoms of anxiety separately when assessing anxiety in MDD and their use in predicting treatment outcome.
  • #15 Dimensions of anxiety in Major depressive disorder and their use in predicting antidepressant treatment outcome: an iSPOT-D report | Psychological Medicine | Cambridge Core
    https://www.cambridge.org/core/journals/psychological-medicine/article/dimensions-of-anxiety-in-major-depressive-disorder-and-their-use-in-predicting-antidepressant-treatment-outcome-an-ispotd-report/C8325C17AD12A83851CD78DB9E1AD770
    Major depressive disorder (MDD) commonly co-occurs with clinically significant levels of anxiety. […] We aimed to identify and characterise dimensions of anxiety in people with MDD and their use in predicting antidepressant treatment outcome. […] Furthermore, only higher somatic anxiety was associated with poorer QIDS-SR16 remission, even after adjusting for covariates and multiple comparisons. […] Anxiety symptoms in people with MDD can be separated onto distinct factors that differentially respond to treatment outcome. […] Future research should consider cognitive and somatic symptoms of anxiety separately when assessing anxiety in MDD and their use in predicting treatment outcome.
  • #16 Prognosis and improved outcomes in major depression: a review
    https://pmc.ncbi.nlm.nih.gov/articles/PMC6447556/
    MDD and several physical diseases including cardiovascular disease and diabetes appear to have bidirectional effects on disease trajectory. […] Structural markers of antidepressant treatment outcomes suggest that hippocampal volumes are related to response and remission. […] Consistent with neuroinflammatory processes, elevated levels of C-reactive protein (CRP), tumor necrosis factor alpha (TNF), and interleukin-6 (IL-6) have been reported in a subset of MDD patients. […] A large, collaborative genome-wide association study (GWAS) detected 44 significant loci associated with MDD. […] While some studies have suggested that depressive subtypes in MDD including anxious, mixed, melancholic, atypical, and psychotic depression respond differently to antidepressant treatment, this literature is mixed.
  • #17 Major depressive disorder – Wikipedia
    https://en.wikipedia.org/wiki/Major_depressive_disorder
    Current guidelines recommend continuing antidepressants for four to six months after remission to prevent relapse. […] Major depressive episodes often resolve over time, whether or not they are treated. […] The median duration of an episode has been estimated to be 23 weeks, with the highest rate of recovery in the first three months. […] According to a 2013 review, 23% of untreated adults with mild to moderate depression will remit within 3 months, 32% within 6 months and 53% within 12 months. […] Depression may affect people’s ability to work. […] Depressed individuals have a shorter life expectancy than those without depression, in part because people who are depressed are at risk of dying of suicide. […] About 50% of people who die of suicide have a mood disorder such as major depression, and the risk is especially high if a person has a marked sense of hopelessness or has both depression and borderline personality disorder.
  • #18 Major depressive disorder – Wikipedia
    https://en.wikipedia.org/wiki/Major_depressive_disorder
    About 2–8% of adults with major depression die by suicide. […] There is a 1.5- to 2-fold increased risk of cardiovascular disease, independent of other known risk factors, and is itself linked directly or indirectly to risk factors such as smoking and obesity. […] Major depression is about twice as common in women as in men, although it is unclear why this is so, and whether factors unaccounted for are contributing to this.
  • #19 Major depressive disorder – Wikipedia
    https://en.wikipedia.org/wiki/Major_depressive_disorder
    Current guidelines recommend continuing antidepressants for four to six months after remission to prevent relapse. […] Major depressive episodes often resolve over time, whether or not they are treated. […] The median duration of an episode has been estimated to be 23 weeks, with the highest rate of recovery in the first three months. […] According to a 2013 review, 23% of untreated adults with mild to moderate depression will remit within 3 months, 32% within 6 months and 53% within 12 months. […] Depression may affect people’s ability to work. […] Depressed individuals have a shorter life expectancy than those without depression, in part because people who are depressed are at risk of dying of suicide. […] About 50% of people who die of suicide have a mood disorder such as major depression, and the risk is especially high if a person has a marked sense of hopelessness or has both depression and borderline personality disorder.
  • #20 Major depressive disorder: hypothesis, mechanism, prevention and treatment | Signal Transduction and Targeted Therapy
    https://www.nature.com/articles/s41392-024-01738-y
    The relationship between the onset of MDD and several diseases is complex and potentially bidirectional in nature. […] The impact of depression on society and the economy is increased by the existence of comorbidities. […] Specifically, in 2018, comorbid disorders rather than MDD itself were responsible for 63% of all costs related to MDD in the United States. […] Furthermore, compared to people without depression, patients with MDD have been demonstrated to have a shorter life expectancy. […] Additionally, the worsening of comorbidities could be a factor in the premature mortality of MDD patients. […] The traditional monoamine theory contends that in addition to common pathogenic factors, deficiencies in monoamine neurotransmitters, such as serotonin (5-HT), dopamine (DA) and norepinephrine (NE), are the root cause of clinical depression.
  • #21 Early Improvement in the First 2 Weeks as a Predictor of Treatment Outcome in Patients With Major Depressive Disorder: A Meta-Analysis Including 6562 Patients
    https://www.psychiatrist.com/jcp/early-improvement-weeks-predictor-treatment-outcome/
    New evidence indicates that treatment response can be predicted with high sensitivity after 2 weeks of treatment. […] Here, we assess whether early improvement with antidepressant treatment predicts treatment outcome in patients with major depressive disorder (MDD). […] Early improvement predicted stable response and stable remission with high sensitivity (81% and 87%, respectively). […] These results indicate that early improvement with antidepressant medication can predict subsequent treatment outcome with high sensitivity in patients with major depressive disorder. […] A lack of improvement during the first 2 weeks of therapy may indicate that changes in depression management should be considered earlier than conventionally thought.
  • #22 Early Improvement in the First 2 Weeks as a Predictor of Treatment Outcome in Patients With Major Depressive Disorder: A Meta-Analysis Including 6562 Patients
    https://www.psychiatrist.com/jcp/early-improvement-weeks-predictor-treatment-outcome/
    New evidence indicates that treatment response can be predicted with high sensitivity after 2 weeks of treatment. […] Here, we assess whether early improvement with antidepressant treatment predicts treatment outcome in patients with major depressive disorder (MDD). […] Early improvement predicted stable response and stable remission with high sensitivity (81% and 87%, respectively). […] These results indicate that early improvement with antidepressant medication can predict subsequent treatment outcome with high sensitivity in patients with major depressive disorder. […] A lack of improvement during the first 2 weeks of therapy may indicate that changes in depression management should be considered earlier than conventionally thought.
  • #23 Early Improvement in the First 2 Weeks as a Predictor of Treatment Outcome in Patients With Major Depressive Disorder: A Meta-Analysis Including 6562 Patients
    https://www.psychiatrist.com/jcp/early-improvement-weeks-predictor-treatment-outcome/
    New evidence indicates that treatment response can be predicted with high sensitivity after 2 weeks of treatment. […] Here, we assess whether early improvement with antidepressant treatment predicts treatment outcome in patients with major depressive disorder (MDD). […] Early improvement predicted stable response and stable remission with high sensitivity (81% and 87%, respectively). […] These results indicate that early improvement with antidepressant medication can predict subsequent treatment outcome with high sensitivity in patients with major depressive disorder. […] A lack of improvement during the first 2 weeks of therapy may indicate that changes in depression management should be considered earlier than conventionally thought.
  • #24 Early Improvement in the First 2 Weeks as a Predictor of Treatment Outcome in Patients With Major Depressive Disorder: A Meta-Analysis Including 6562 Patients
    https://www.psychiatrist.com/jcp/early-improvement-weeks-predictor-treatment-outcome/
    New evidence indicates that treatment response can be predicted with high sensitivity after 2 weeks of treatment. […] Here, we assess whether early improvement with antidepressant treatment predicts treatment outcome in patients with major depressive disorder (MDD). […] Early improvement predicted stable response and stable remission with high sensitivity (81% and 87%, respectively). […] These results indicate that early improvement with antidepressant medication can predict subsequent treatment outcome with high sensitivity in patients with major depressive disorder. […] A lack of improvement during the first 2 weeks of therapy may indicate that changes in depression management should be considered earlier than conventionally thought.
  • #25 Prognosis and improved outcomes in major depression: a review
    https://pmc.ncbi.nlm.nih.gov/articles/PMC6447556/
    Another important clinical variable is time to antidepressant response. […] Early response to antidepressant treatment appears to occur independently of treatment modality or outcome parameters. […] This suggests that TRD defined loosely here as non-response to at least two adequate antidepressant trials and chronic depression may have similar response slopes in the earliest treatment stages. […] The influence of sociodemographic factors such as age, age of onset, gender, and number of previous episodes on treatment outcome has been investigated with mixed results. […] High stress levels significantly influence outcomes in MDD patients who are prone to vulnerable states, such as those with high levels of neuroticism. […] Psychiatric comorbidity has been shown to influence outcome in both treated and untreated patients.
  • #26 Prognosis and improved outcomes in major depression: a review | Translational Psychiatry
    https://www.nature.com/articles/s41398-019-0460-3
    Another important clinical variable is time to antidepressant response. […] Early response to antidepressant treatment appears to occur independently of treatment modality or outcome parameters. […] This suggests that TRD defined loosely here as non-response to at least two adequate antidepressant trials and chronic depression (roughly defined here as non-response to any treatment) may have similar response slopes in the earliest treatment stages. […] Lower baseline function and quality of life including longer duration of the current index episode have been associated with lower remission rates to various types of antidepressant treatments. […] Worse outcomes in more severely ill patients at baseline were also reported in elderly patients treated in primary-care settings. […] Psychiatric comorbidity has been shown to influence outcome in both treated and untreated patients.
  • #27 Prognosis and improved outcomes in major depression: a review | Translational Psychiatry
    https://www.nature.com/articles/s41398-019-0460-3
    Another important clinical variable is time to antidepressant response. […] Early response to antidepressant treatment appears to occur independently of treatment modality or outcome parameters. […] This suggests that TRD defined loosely here as non-response to at least two adequate antidepressant trials and chronic depression (roughly defined here as non-response to any treatment) may have similar response slopes in the earliest treatment stages. […] Lower baseline function and quality of life including longer duration of the current index episode have been associated with lower remission rates to various types of antidepressant treatments. […] Worse outcomes in more severely ill patients at baseline were also reported in elderly patients treated in primary-care settings. […] Psychiatric comorbidity has been shown to influence outcome in both treated and untreated patients.
  • #28 Prognosis and improved outcomes in major depression: a review
    https://pmc.ncbi.nlm.nih.gov/articles/PMC6447556/
    MDD and several physical diseases including cardiovascular disease and diabetes appear to have bidirectional effects on disease trajectory. […] Structural markers of antidepressant treatment outcomes suggest that hippocampal volumes are related to response and remission. […] Consistent with neuroinflammatory processes, elevated levels of C-reactive protein (CRP), tumor necrosis factor alpha (TNF), and interleukin-6 (IL-6) have been reported in a subset of MDD patients. […] A large, collaborative genome-wide association study (GWAS) detected 44 significant loci associated with MDD. […] While some studies have suggested that depressive subtypes in MDD including anxious, mixed, melancholic, atypical, and psychotic depression respond differently to antidepressant treatment, this literature is mixed.
  • #29 Prognosis and improved outcomes in major depression: a review | Translational Psychiatry
    https://www.nature.com/articles/s41398-019-0460-3
    Studies have found that elevated baseline anxiety symptoms or comorbid anxiety disorder are associated with worse antidepressant response to first-line selective serotonin reuptake inhibitors (SSRIs) or second-line treatment strategies. […] The connection appears to be relevant at any stage of the disease, as number of physical comorbidities did not separate TRD from non-TRD patients. […] The volume of other brain regions, including the anterior cingulate or orbitofrontal cortices, have also been shown to be decreased in MDD subjects, but more longitudinal neuroimaging trials with antidepressants are needed to clarify this association. […] Elevated levels of C-reactive protein (CRP), tumor necrosis factor alpha (TNF), and interleukin-6 (IL-6) have been reported in a subset of MDD patients.
  • #30 Prognosis and improved outcomes in major depression: a review | Translational Psychiatry
    https://www.nature.com/articles/s41398-019-0460-3
    A longitudinal study found that lower CRP levels were associated with quicker response to SSRIs, an association not observed for SSRI-bupropion combination therapy. […] Compelling evidence suggests that BDNF levels are decreased at baseline in MDD patients and elevated in response to pharmacological treatments as well as ECT. […] The studies reviewed above also underscore the manner in which SLEs, as well as physical and psychiatric comorbidities, contribute to impaired outcomes. […] Together, these factors contribute toward treatment resistance, which has gained a substantial amount of importance as a patient-stratifying variable. […] This review outlines important clinical, psychosocial, and biological factors associated with response and remission to antidepressant treatment. […] Key discoveries into novel rapid-acting substances, in concert with improvements in brain stimulation techniques, may also result in significantly improved treatment outcomes in formerly hard-to-treat patients.
  • #31 Prognosis and improved outcomes in major depression: a review | Translational Psychiatry
    https://www.nature.com/articles/s41398-019-0460-3
    A longitudinal study found that lower CRP levels were associated with quicker response to SSRIs, an association not observed for SSRI-bupropion combination therapy. […] Compelling evidence suggests that BDNF levels are decreased at baseline in MDD patients and elevated in response to pharmacological treatments as well as ECT. […] The studies reviewed above also underscore the manner in which SLEs, as well as physical and psychiatric comorbidities, contribute to impaired outcomes. […] Together, these factors contribute toward treatment resistance, which has gained a substantial amount of importance as a patient-stratifying variable. […] This review outlines important clinical, psychosocial, and biological factors associated with response and remission to antidepressant treatment. […] Key discoveries into novel rapid-acting substances, in concert with improvements in brain stimulation techniques, may also result in significantly improved treatment outcomes in formerly hard-to-treat patients.
  • #32 Prognosis and improved outcomes in major depression: a review
    https://pmc.ncbi.nlm.nih.gov/articles/PMC6447556/
    MDD and several physical diseases including cardiovascular disease and diabetes appear to have bidirectional effects on disease trajectory. […] Structural markers of antidepressant treatment outcomes suggest that hippocampal volumes are related to response and remission. […] Consistent with neuroinflammatory processes, elevated levels of C-reactive protein (CRP), tumor necrosis factor alpha (TNF), and interleukin-6 (IL-6) have been reported in a subset of MDD patients. […] A large, collaborative genome-wide association study (GWAS) detected 44 significant loci associated with MDD. […] While some studies have suggested that depressive subtypes in MDD including anxious, mixed, melancholic, atypical, and psychotic depression respond differently to antidepressant treatment, this literature is mixed.
  • #33 Prognosis and improved outcomes in major depression: a review | Translational Psychiatry
    https://www.nature.com/articles/s41398-019-0460-3
    Studies have found that elevated baseline anxiety symptoms or comorbid anxiety disorder are associated with worse antidepressant response to first-line selective serotonin reuptake inhibitors (SSRIs) or second-line treatment strategies. […] The connection appears to be relevant at any stage of the disease, as number of physical comorbidities did not separate TRD from non-TRD patients. […] The volume of other brain regions, including the anterior cingulate or orbitofrontal cortices, have also been shown to be decreased in MDD subjects, but more longitudinal neuroimaging trials with antidepressants are needed to clarify this association. […] Elevated levels of C-reactive protein (CRP), tumor necrosis factor alpha (TNF), and interleukin-6 (IL-6) have been reported in a subset of MDD patients.
  • #34 A wavelet-based technique to predict treatment outcome for Major Depressive Disorder | PLOS One
    https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0171409
    The ATR method predicts antidepressants treatment outcome with ~74% accuracy. However, the method suffers from the disadvantage that it can predict the treatment outcome based on the data acquired during week 0 (pretreatment) and 1 (one week after treatment start). […] In conclusion, despite the above mentioned limitations, the higher efficiencies shown in the results suggest that wavelet features from delta and theta bands might be a promising tool for prediction of therapeutic actions for SSRIs treatment. Specifically, the high specificities achieved by our method are of considerable interest for their clinical utilities.
  • #35 A wavelet-based technique to predict treatment outcome for Major Depressive Disorder | PLOS One
    https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0171409
    The ATR method predicts antidepressants treatment outcome with ~74% accuracy. However, the method suffers from the disadvantage that it can predict the treatment outcome based on the data acquired during week 0 (pretreatment) and 1 (one week after treatment start). […] In conclusion, despite the above mentioned limitations, the higher efficiencies shown in the results suggest that wavelet features from delta and theta bands might be a promising tool for prediction of therapeutic actions for SSRIs treatment. Specifically, the high specificities achieved by our method are of considerable interest for their clinical utilities.
  • #36 Magnetic resonance imaging for individual prediction of treatment response in major depressive disorder: a systematic review and meta-analysis | medRxiv
    https://www.medrxiv.org/content/10.1101/2020.06.27.20141465.full
    Objective No tools are currently available to predict whether a patient suffering from major depressive disorder (MDD) will respond to a certain treatment. […] Prediction of treatment response using machine learning analysis of MRI data is promising but should not yet be implemented into clinical practice. Future studies with more generalizable samples and external validation are needed to establish the potential of MRI to realize individualized patient care in MDD. […] Our results show that machine learning analysis of MRI data can predict antidepressive treatment success with an AUC of 0.84, 77% sensitivity, and 79% specificity. […] Although ECT showed somewhat higher sensitivity and specificity, confidence intervals largely overlapped between the two intervention types. […] In conclusion, prediction of treatment success using machine learning analysis of MRI data holds promise but has not transcended the research status and should not yet be implemented into clinical practice.
  • #37 Magnetic resonance imaging for individual prediction of treatment response in major depressive disorder: a systematic review and meta-analysis | medRxiv
    https://www.medrxiv.org/content/10.1101/2020.06.27.20141465.full
    Objective No tools are currently available to predict whether a patient suffering from major depressive disorder (MDD) will respond to a certain treatment. […] Prediction of treatment response using machine learning analysis of MRI data is promising but should not yet be implemented into clinical practice. Future studies with more generalizable samples and external validation are needed to establish the potential of MRI to realize individualized patient care in MDD. […] Our results show that machine learning analysis of MRI data can predict antidepressive treatment success with an AUC of 0.84, 77% sensitivity, and 79% specificity. […] Although ECT showed somewhat higher sensitivity and specificity, confidence intervals largely overlapped between the two intervention types. […] In conclusion, prediction of treatment success using machine learning analysis of MRI data holds promise but has not transcended the research status and should not yet be implemented into clinical practice.
  • #38 Predicting the treatment outcomes of major depressive disorder interventions with baseline resting-state functional connectivity: a meta-analysis | BMC Psychiatry | Full Text
    https://bmcpsychiatry.biomedcentral.com/articles/10.1186/s12888-025-06728-0
    Overall, we found a small predictive effect that rsFC has on the treatment outcome of MDD interventions. […] The rsFC within the DMN had a small but significant effect in predicting the general treatment response for MDD interventions. […] Our pooled evidence thus suggested that baseline rsFC within the DMN and between the DMN and FPN had a small and differential predictability on the outcome of antidepressants and non-invasive brain stimulation, respectively.
  • #39 Predicting the treatment outcomes of major depressive disorder interventions with baseline resting-state functional connectivity: a meta-analysis | BMC Psychiatry | Full Text
    https://bmcpsychiatry.biomedcentral.com/articles/10.1186/s12888-025-06728-0
    Overall, we found a small predictive effect that rsFC has on the treatment outcome of MDD interventions. […] The rsFC within the DMN had a small but significant effect in predicting the general treatment response for MDD interventions. […] Our pooled evidence thus suggested that baseline rsFC within the DMN and between the DMN and FPN had a small and differential predictability on the outcome of antidepressants and non-invasive brain stimulation, respectively.
  • #40 Optimizing and Predicting Antidepressant Efficacy in Patients with Major Depressive Disorder Using Multi-Omics Analysis and the Opade AI Prediction Tools
    https://www.mdpi.com/2076-3425/14/7/658
    Even the most advanced treatments often fail to produce long-lasting results, with about 40–50% of patients experiencing a relapse within 1–2 years of treatment. […] Treatment-resistant depression (TRD) refers to a lack of response to adequate trials of medications or other antidepressant treatments. Studies suggest that 30–50% of patients with major depressive disorder (MDD) do not respond to initial antidepressant trials, and approximately 20% remain depressed up to 2 years after onset. […] The OPADE project will evaluate the interplay between genetic, epigenetic, environmental, and inflammatory factors to improve decision-making regarding assessment, accurate diagnosis, and appropriate treatment, considering possible alternative patient responses, observing outcomes, and adjusting processes accordingly.
  • #41 Prognosis and improved outcomes in major depression: a review
    https://pmc.ncbi.nlm.nih.gov/articles/PMC6447556/
    Cross-sectional data from the GSRD identified a number of risk factors linked to TRD, including comorbidity, suicide risk, episode severity, number of hospitalizations, episode recurrence, early-onset, melancholic features, and non-response at first treatment. […] Taken together, the evidence indicates that TRD patients need special attention, as outcomes in these individuals are significantly worse. […] The studies reviewed above also underscore the manner in which SLEs, as well as physical and psychiatric comorbidities, contribute to impaired outcomes. […] This paper also reviewed biological markers, where research has grown exponentially to encompass enormous projects with potentially tens of thousands of subjects enrolled in real world studies. […] In combination with neuroimaging techniques such as fMRI, genes or blood-based markers have a high potential of future implementation in stratification of MDD or serve as prognostic marker on treatment outcome. […] Recent studies have led to important insights into neurobiological disease markers that could result in improved disease stratification and response prediction in the near future.
  • #42 Prognosis and improved outcomes in major depression: a review
    https://pmc.ncbi.nlm.nih.gov/articles/PMC6447556/
    Cross-sectional data from the GSRD identified a number of risk factors linked to TRD, including comorbidity, suicide risk, episode severity, number of hospitalizations, episode recurrence, early-onset, melancholic features, and non-response at first treatment. […] Taken together, the evidence indicates that TRD patients need special attention, as outcomes in these individuals are significantly worse. […] The studies reviewed above also underscore the manner in which SLEs, as well as physical and psychiatric comorbidities, contribute to impaired outcomes. […] This paper also reviewed biological markers, where research has grown exponentially to encompass enormous projects with potentially tens of thousands of subjects enrolled in real world studies. […] In combination with neuroimaging techniques such as fMRI, genes or blood-based markers have a high potential of future implementation in stratification of MDD or serve as prognostic marker on treatment outcome. […] Recent studies have led to important insights into neurobiological disease markers that could result in improved disease stratification and response prediction in the near future.
  • #43 Prognosis and improved outcomes in major depression: a review
    https://pmc.ncbi.nlm.nih.gov/articles/PMC6447556/
    Cross-sectional data from the GSRD identified a number of risk factors linked to TRD, including comorbidity, suicide risk, episode severity, number of hospitalizations, episode recurrence, early-onset, melancholic features, and non-response at first treatment. […] Taken together, the evidence indicates that TRD patients need special attention, as outcomes in these individuals are significantly worse. […] The studies reviewed above also underscore the manner in which SLEs, as well as physical and psychiatric comorbidities, contribute to impaired outcomes. […] This paper also reviewed biological markers, where research has grown exponentially to encompass enormous projects with potentially tens of thousands of subjects enrolled in real world studies. […] In combination with neuroimaging techniques such as fMRI, genes or blood-based markers have a high potential of future implementation in stratification of MDD or serve as prognostic marker on treatment outcome. […] Recent studies have led to important insights into neurobiological disease markers that could result in improved disease stratification and response prediction in the near future.
  • #44 Prognosis and improved outcomes in major depression: a review | Translational Psychiatry
    https://www.nature.com/articles/s41398-019-0460-3
    A longitudinal study found that lower CRP levels were associated with quicker response to SSRIs, an association not observed for SSRI-bupropion combination therapy. […] Compelling evidence suggests that BDNF levels are decreased at baseline in MDD patients and elevated in response to pharmacological treatments as well as ECT. […] The studies reviewed above also underscore the manner in which SLEs, as well as physical and psychiatric comorbidities, contribute to impaired outcomes. […] Together, these factors contribute toward treatment resistance, which has gained a substantial amount of importance as a patient-stratifying variable. […] This review outlines important clinical, psychosocial, and biological factors associated with response and remission to antidepressant treatment. […] Key discoveries into novel rapid-acting substances, in concert with improvements in brain stimulation techniques, may also result in significantly improved treatment outcomes in formerly hard-to-treat patients.
  • #45 Predicting relapse or recurrence of depression: systematic review of prognostic models | The British Journal of Psychiatry | Cambridge Core
    https://www.cambridge.org/core/journals/the-british-journal-of-psychiatry/article/predicting-relapse-or-recurrence-of-depression-systematic-review-of-prognostic-models/64E2A0298FBD0B70E360729993F6371B
    Relapse and recurrence of depression are common, contributing to the overall burden of depression globally. Accurate prediction of relapse or recurrence while patients are well would allow the identification of high-risk individuals and may effectively guide the allocation of interventions to prevent relapse and recurrence. […] To review prognostic models developed to predict the risk of relapse, recurrence, sustained remission, or recovery in adults with remitted major depressive disorder. […] Due to high risk of bias of the included studies, poor predictive performance and limited external validation of the models identified, presently available clinical prediction models for relapse and recurrence of depression are not yet sufficiently developed for deploying in clinical settings. […] Reliable prediction of individuals risk of relapse and recurrence might enable a precision medicine approach to relapse prevention, personalising the allocation and potentially type of relapse prevention interventions offered to ensure maximum benefit.
  • #46 Predicting relapse or recurrence of depression: systematic review of prognostic models | The British Journal of Psychiatry | Cambridge Core
    https://www.cambridge.org/core/journals/the-british-journal-of-psychiatry/article/predicting-relapse-or-recurrence-of-depression-systematic-review-of-prognostic-models/64E2A0298FBD0B70E360729993F6371B
    Relapse and recurrence of depression are common, contributing to the overall burden of depression globally. Accurate prediction of relapse or recurrence while patients are well would allow the identification of high-risk individuals and may effectively guide the allocation of interventions to prevent relapse and recurrence. […] To review prognostic models developed to predict the risk of relapse, recurrence, sustained remission, or recovery in adults with remitted major depressive disorder. […] Due to high risk of bias of the included studies, poor predictive performance and limited external validation of the models identified, presently available clinical prediction models for relapse and recurrence of depression are not yet sufficiently developed for deploying in clinical settings. […] Reliable prediction of individuals risk of relapse and recurrence might enable a precision medicine approach to relapse prevention, personalising the allocation and potentially type of relapse prevention interventions offered to ensure maximum benefit.
  • #47 Optimizing and Predicting Antidepressant Efficacy in Patients with Major Depressive Disorder Using Multi-Omics Analysis and the Opade AI Prediction Tools
    https://www.mdpi.com/2076-3425/14/7/658
    Even the most advanced treatments often fail to produce long-lasting results, with about 40–50% of patients experiencing a relapse within 1–2 years of treatment. […] Treatment-resistant depression (TRD) refers to a lack of response to adequate trials of medications or other antidepressant treatments. Studies suggest that 30–50% of patients with major depressive disorder (MDD) do not respond to initial antidepressant trials, and approximately 20% remain depressed up to 2 years after onset. […] The OPADE project will evaluate the interplay between genetic, epigenetic, environmental, and inflammatory factors to improve decision-making regarding assessment, accurate diagnosis, and appropriate treatment, considering possible alternative patient responses, observing outcomes, and adjusting processes accordingly.
  • #48 Optimizing and Predicting Antidepressant Efficacy in Patients with Major Depressive Disorder Using Multi-Omics Analysis and the Opade AI Prediction Tools
    https://www.mdpi.com/2076-3425/14/7/658
    Machine learning algorithms offer significant assistance in diagnosing and prognosticating major depressive disorder (MDD) despite its uniform presence among subjects. These algorithms perform several crucial functions: subtyping MDD or assessing its severity using features like symptom profiles and biomarkers, enabling tailored treatment strategies. They predict treatment responses based on genetic profiles and clinical data, offering personalized plans. […] Overall, despite the homogeneity of MDD presence among subjects, machine learning algorithms significantly enhance diagnostic accuracy, optimize treatment selection, and improve patient outcomes through personalized and data-driven approaches.
  • #49 Prognosis of Depressive Disorder | PortalCLÍNIC
    https://www.clinicbarcelona.org/en/assistance/diseases/depressive-disorder/evolution-of-the-disease
    The prognosis of the illness is usually very much associated with the presence of triggering factors. When the depressive disorder appears totally spontaneously, the prognosis is usually better. On the other hand, when it is associated with some precipitating event or with personality traits of the patient, it usually has a tendency towards becoming chronic (or put another way, a poor response to the treatment). […] The main long-term complication of depressive disorders, particularly in the dysthymia subtypes and major depression, is the increased tendency for relapses. […] It is not possible to predict who will have them in a recurrent course and who will not. However, there are certain variables that are associated with a higher or lower tendency to present with new episodes. […] It must be remembered that depressive disorders can have a trigger (for example, a stressful environmental situation), or can apparently be spontaneous. Therefore, it is important to highlight that it is very characteristic of the depressive disorders that the greater the number of previous episodes the more autonomy of the disorder; that is to say, the more previous episodes, it is more probable that the next episode may not have an external trigger.
  • #50 Prognosis of Depressive Disorder | PortalCLÍNIC
    https://www.clinicbarcelona.org/en/assistance/diseases/depressive-disorder/evolution-of-the-disease
    The prognosis of the illness is usually very much associated with the presence of triggering factors. When the depressive disorder appears totally spontaneously, the prognosis is usually better. On the other hand, when it is associated with some precipitating event or with personality traits of the patient, it usually has a tendency towards becoming chronic (or put another way, a poor response to the treatment). […] The main long-term complication of depressive disorders, particularly in the dysthymia subtypes and major depression, is the increased tendency for relapses. […] It is not possible to predict who will have them in a recurrent course and who will not. However, there are certain variables that are associated with a higher or lower tendency to present with new episodes. […] It must be remembered that depressive disorders can have a trigger (for example, a stressful environmental situation), or can apparently be spontaneous. Therefore, it is important to highlight that it is very characteristic of the depressive disorders that the greater the number of previous episodes the more autonomy of the disorder; that is to say, the more previous episodes, it is more probable that the next episode may not have an external trigger.
  • #51 Prognosis of Depressive Disorder | PortalCLÍNIC
    https://www.clinicbarcelona.org/en/assistance/diseases/depressive-disorder/evolution-of-the-disease
    The prognosis of the illness is usually very much associated with the presence of triggering factors. When the depressive disorder appears totally spontaneously, the prognosis is usually better. On the other hand, when it is associated with some precipitating event or with personality traits of the patient, it usually has a tendency towards becoming chronic (or put another way, a poor response to the treatment). […] The main long-term complication of depressive disorders, particularly in the dysthymia subtypes and major depression, is the increased tendency for relapses. […] It is not possible to predict who will have them in a recurrent course and who will not. However, there are certain variables that are associated with a higher or lower tendency to present with new episodes. […] It must be remembered that depressive disorders can have a trigger (for example, a stressful environmental situation), or can apparently be spontaneous. Therefore, it is important to highlight that it is very characteristic of the depressive disorders that the greater the number of previous episodes the more autonomy of the disorder; that is to say, the more previous episodes, it is more probable that the next episode may not have an external trigger.
  • #52
    https://link.springer.com/article/10.1007/s00406-021-01285-5
    Adopting a personalized medicine approach beyond genetic/epigenetic profiling within psychiatric diagnostic and treatment is challenging. For the first time, we studied the influence of two patient resources (resilience and illness representation) on the success of an inpatient treatment of major depressive disorder (MDD). […] The patients illness representation [measured by the Krankheitskonzeptskala (KK)] did not predict their treatment- success. […] Albeit, the patients resilience (determined by Resilience-Scale, 11-item-version (RS-11)) negatively predicted their positive treatment- success (b= 0.09, p=0.017, f2=0.11). This influence of resilience on treatment- success was completely mediated by the baseline-depression- severity. This means, patients with low resilience reported high baseline-depression-levels which predicted a significant positive treatment- success. And, patients with high resilience reported low baseline-depression-levels which predicted no relevant or even negative inpatient treatment-success.
  • #53
    https://link.springer.com/article/10.1007/s00406-021-01285-5
    Inpatients resilience was found to be negatively associated with the success of a 5 weeks lasting MDD- treatment. This relationship was fully mediated by the patients subjective depression severity at baseline. Patients who felt more severely depressed at baseline, experienced the best treatment success at study endpoint, which was in line with the previous investigations. […] The other personal resource, the concept-of-illness, was not associated with the treatment success or resilience. […] The effect size of the influence of resilience on the treatment- success was low. […] We propose adopting a personalized medicine approach also within psychiatric diagnostic and treatment processes (e.g., by assessing patient- resources such as resilience) and beyond genetic profiling and medication matching. […] Within the limitations of this study, we corroborate the reputation of resilience as a protective factor for MDD although resilience was found to be a (weak) negative predictor for inpatient treatment-success of MDD.
  • #54
    https://link.springer.com/article/10.1007/s00406-021-01285-5
    Inpatients resilience was found to be negatively associated with the success of a 5 weeks lasting MDD- treatment. This relationship was fully mediated by the patients subjective depression severity at baseline. Patients who felt more severely depressed at baseline, experienced the best treatment success at study endpoint, which was in line with the previous investigations. […] The other personal resource, the concept-of-illness, was not associated with the treatment success or resilience. […] The effect size of the influence of resilience on the treatment- success was low. […] We propose adopting a personalized medicine approach also within psychiatric diagnostic and treatment processes (e.g., by assessing patient- resources such as resilience) and beyond genetic profiling and medication matching. […] Within the limitations of this study, we corroborate the reputation of resilience as a protective factor for MDD although resilience was found to be a (weak) negative predictor for inpatient treatment-success of MDD.
  • #55 Prognosis and improved outcomes in major depression: a review
    https://pmc.ncbi.nlm.nih.gov/articles/PMC6447556/
    Treatment outcomes for major depressive disorder (MDD) need to be improved. Presently, no clinically relevant tools have been established for stratifying subgroups or predicting outcomes. […] The results show that early recognition and treatment are crucial, as duration of untreated depression correlates with worse outcomes. Early improvement is associated with response and remission, while comorbidities prolong course of illness. […] Clear evidence of an inverse relationship between duration of episode and treatment outcome (either response or remission) underscores the importance of early intervention in MDD. […] In particular, replicable prospective and retrospective studies indicate that shorter duration of untreated disease both in terms of first and recurrent episodes is a prognostic factor indicating better treatment response and better long-term outcomes.
  • #56 Prognosis and improved outcomes in major depression: a review
    https://pmc.ncbi.nlm.nih.gov/articles/PMC6447556/
    Treatment outcomes for major depressive disorder (MDD) need to be improved. Presently, no clinically relevant tools have been established for stratifying subgroups or predicting outcomes. […] The results show that early recognition and treatment are crucial, as duration of untreated depression correlates with worse outcomes. Early improvement is associated with response and remission, while comorbidities prolong course of illness. […] Clear evidence of an inverse relationship between duration of episode and treatment outcome (either response or remission) underscores the importance of early intervention in MDD. […] In particular, replicable prospective and retrospective studies indicate that shorter duration of untreated disease both in terms of first and recurrent episodes is a prognostic factor indicating better treatment response and better long-term outcomes.
  • #57 Prognosis and improved outcomes in major depression: a review
    https://pmc.ncbi.nlm.nih.gov/articles/PMC6447556/
    Another important clinical variable is time to antidepressant response. […] Early response to antidepressant treatment appears to occur independently of treatment modality or outcome parameters. […] This suggests that TRD defined loosely here as non-response to at least two adequate antidepressant trials and chronic depression may have similar response slopes in the earliest treatment stages. […] The influence of sociodemographic factors such as age, age of onset, gender, and number of previous episodes on treatment outcome has been investigated with mixed results. […] High stress levels significantly influence outcomes in MDD patients who are prone to vulnerable states, such as those with high levels of neuroticism. […] Psychiatric comorbidity has been shown to influence outcome in both treated and untreated patients.
  • #58 Prognosis and improved outcomes in major depression: a review
    https://pmc.ncbi.nlm.nih.gov/articles/PMC6447556/
    Another important clinical variable is time to antidepressant response. […] Early response to antidepressant treatment appears to occur independently of treatment modality or outcome parameters. […] This suggests that TRD defined loosely here as non-response to at least two adequate antidepressant trials and chronic depression may have similar response slopes in the earliest treatment stages. […] The influence of sociodemographic factors such as age, age of onset, gender, and number of previous episodes on treatment outcome has been investigated with mixed results. […] High stress levels significantly influence outcomes in MDD patients who are prone to vulnerable states, such as those with high levels of neuroticism. […] Psychiatric comorbidity has been shown to influence outcome in both treated and untreated patients.
  • #59 Prognosis and improved outcomes in major depression: a review
    https://pmc.ncbi.nlm.nih.gov/articles/PMC6447556/
    Cross-sectional data from the GSRD identified a number of risk factors linked to TRD, including comorbidity, suicide risk, episode severity, number of hospitalizations, episode recurrence, early-onset, melancholic features, and non-response at first treatment. […] Taken together, the evidence indicates that TRD patients need special attention, as outcomes in these individuals are significantly worse. […] The studies reviewed above also underscore the manner in which SLEs, as well as physical and psychiatric comorbidities, contribute to impaired outcomes. […] This paper also reviewed biological markers, where research has grown exponentially to encompass enormous projects with potentially tens of thousands of subjects enrolled in real world studies. […] In combination with neuroimaging techniques such as fMRI, genes or blood-based markers have a high potential of future implementation in stratification of MDD or serve as prognostic marker on treatment outcome. […] Recent studies have led to important insights into neurobiological disease markers that could result in improved disease stratification and response prediction in the near future.
  • #60 Prognosis and improved outcomes in major depression: a review | Translational Psychiatry
    https://www.nature.com/articles/s41398-019-0460-3
    A longitudinal study found that lower CRP levels were associated with quicker response to SSRIs, an association not observed for SSRI-bupropion combination therapy. […] Compelling evidence suggests that BDNF levels are decreased at baseline in MDD patients and elevated in response to pharmacological treatments as well as ECT. […] The studies reviewed above also underscore the manner in which SLEs, as well as physical and psychiatric comorbidities, contribute to impaired outcomes. […] Together, these factors contribute toward treatment resistance, which has gained a substantial amount of importance as a patient-stratifying variable. […] This review outlines important clinical, psychosocial, and biological factors associated with response and remission to antidepressant treatment. […] Key discoveries into novel rapid-acting substances, in concert with improvements in brain stimulation techniques, may also result in significantly improved treatment outcomes in formerly hard-to-treat patients.

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