There are numerous treatments designed to address the multiple facets of depression. They include medication, psychotherapy, exercise, mindfulness, breathing exercises, light therapy, sleep therapy, and behavioral therapy. However, not every individual with depression will respond equally to any or all of these treatments. Some individuals demonstrate treatment resistance and poorer outcomes than others. Understanding which mechanisms lead to negative outcomes could help clinicians target those symptoms specifically in depressed individuals. In an attempt to identify which factors lead to treatment resistance, Rudolf Uher of the MRC Social, Genetic, and Developmental Psychiatry Centre at King’s College Institute of Psychiatry in London conducted a study that examined nine specific depressive symptom dimensions in a sample of 811 participants with depression. All of the participants were receiving antidepressant medications and were evaluated for response and symptom severity. One of the goals of the study was to not only identify specific dimensions of depression, but to replicate the findings in a larger sample.
Uher discovered a unique dimension of depression that predicted treatment resistance in his participants. He found that those with the least amount of activity, interest, or enjoyment and with the highest levels of indecisiveness were the most resistant to antidepressants. Uher also discovered that this finding was consistent regardless of the level of symptom severity or type of antidepressant that the participants were given. Additionally, this same dimension was found to predict negative treatment outcomes in a larger sample of over 3,000 participants in the Sequenced Treatment Alternatives to Relieve Depression (STAR*D) study.
The findings of Uher’s smaller study, and the replication of results on a broader scale, clearly demonstrate that these specific symptoms of depression create unique barriers to positive outcomes. This knowledge could help clinicians design treatments for individuals who have this dimension of depression. Rather than subjecting them to traditional therapy at the onset of treatment, mental health professionals may wish to try alternative approaches first. Uher said, “Although no evidence for such treatments in depression with loss of interest and decreased activity is available at present, indirect evidence suggests that several approaches may be effective.” Some such approaches that have been shown to be effective in treatment-resistant individuals are exercise, behavioral activation, and psychological therapeutic interventions.
Uher, R., Perlis, R. H., Henigsberg, N., Zobel, A., Rietschel, M. (2012). Depression symptom dimensions as predictors of antidepressant treatment outcome: Replicable evidence for interest-activity symptoms. Psychological Medicine, 42.5, 967-980.
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