Long-term symptomatic and functional outcome following an intensive inpatient multidisciplinary intervention for treatment-resistant affective disorders

Sarah C Wooderson; Abebaw Fekadu; Kalypso Markopoulou; Lena J Rane; Lucia Poon; Mario F Juruena; Rebecca Strawbridge; Anthony J Cleare

doi:10.1016/j.jad.2014.05.013

Long-term symptomatic and functional outcome following an intensive inpatient multidisciplinary intervention for treatment-resistant affective disorders

J Affect Disord. 2014 Sep:166:334-42. doi: 10.1016/j.jad.2014.05.013. Epub 2014 May 21.

Authors

Sarah C Wooderson¹, Abebaw Fekadu², Kalypso Markopoulou¹, Lena J Rane¹, Lucia Poon³, Mario F Juruena⁴, Rebecca Strawbridge⁵, Anthony J Cleare⁶

Affiliations

¹ King׳s College London, Institute of Psychiatry, Department of Psychological Medicine, Affective Disorders Research Group, 103 Denmark Hill, London SE5 8AZ, UK; The National Affective Disorders Unit, South London and Maudsley NHS Foundation Trust, Bethlem Royal Hospital, Monks Orchard Road, Beckenham, Kent BR3 3BX, UK.
² King׳s College London, Institute of Psychiatry, Department of Psychological Medicine, Affective Disorders Research Group, 103 Denmark Hill, London SE5 8AZ, UK; The National Affective Disorders Unit, South London and Maudsley NHS Foundation Trust, Bethlem Royal Hospital, Monks Orchard Road, Beckenham, Kent BR3 3BX, UK; Addis Ababa University, College of Health Sciences, Department of Psychiatry, Addis Ababa, Ethiopia.
³ The National Affective Disorders Unit, South London and Maudsley NHS Foundation Trust, Bethlem Royal Hospital, Monks Orchard Road, Beckenham, Kent BR3 3BX, UK.
⁴ King׳s College London, Institute of Psychiatry, Department of Psychological Medicine, Affective Disorders Research Group, 103 Denmark Hill, London SE5 8AZ, UK; The National Affective Disorders Unit, South London and Maudsley NHS Foundation Trust, Bethlem Royal Hospital, Monks Orchard Road, Beckenham, Kent BR3 3BX, UK; Stress and Affective Disorders (SAD) Programme, Faculty of Medicine of Ribeirao Preto, University of Sao Paulo, Ribeirao Preto, Brazil.
⁵ King׳s College London, Institute of Psychiatry, Department of Psychological Medicine, Affective Disorders Research Group, 103 Denmark Hill, London SE5 8AZ, UK.
⁶ King׳s College London, Institute of Psychiatry, Department of Psychological Medicine, Affective Disorders Research Group, 103 Denmark Hill, London SE5 8AZ, UK; The National Affective Disorders Unit, South London and Maudsley NHS Foundation Trust, Bethlem Royal Hospital, Monks Orchard Road, Beckenham, Kent BR3 3BX, UK; The NIHR Biomedical Research Centre at the South London and Maudsley NHS Foundation Trust and the Institute of Psychiatry, King׳s College London, London, UK. Electronic address: anthony.cleare@kcl.ac.uk.

PMID: 25012450
DOI: 10.1016/j.jad.2014.05.013

Abstract

Background: The natural history of treatment-resistant depression (TRD) is poor, with high rates of chronicity and recurrence. We describe longer-term symptomatic and functional outcome following multimodal intensive inpatient treatment for TRD.

Methods: Symptomatic and functional outcomes were assessed in 71 participants (unipolar, n=51; bipolar, n=20) with severe TRD previously treated at a specialist inpatient unit a median of 34 months (IQR 19-52) post discharge. We looked at outcomes in defined subgroups (unipolar, bipolar and psychotic) and at symptom clusters to see whether certain aspects of depression were more resistant to treatment than others.

Results: Symptomatic improvement during the admission was maintained at follow up: HDRS21 scores fell from admission (median 22; IQR 19-25) to discharge (median 12; IQR 7-16) and follow-up (median 10; IQR 4-18). Overall, two-thirds of patients were judged to have a good long-term outcome, while half remained in full remission at follow-up. Outcomes were more favourable in bipolar patients, patients without a history of psychosis and patients who were discharged in remission, although a minority of responders at discharge no longer met response criteria at follow up, and conversely some patients discharged as non-responders did subsequently respond. Non-remitting depression was characterised by three main factors; anxiety, cognitive difficulties and sleep disturbance. Those who remitted had better functional outcomes as did those who had experienced a more sustained response to treatment whilst inpatients. Quality of life was poor for those who did not respond to the treatment package.

Limitations: Variable follow-up length.

Conclusions: This difficult-to-treat population gained long-term benefits from multidisciplinary inpatient treatment. Treatment to remission was associated with more favourable outcomes. Non-responsive depression was characterised by specific symptom clusters that might be amenable to more targeted treatments.

Keywords: Affective disorders; Long-term outcome; Quality of life; Remission; Specialist treatment; Treatment-resistant depression.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Adult
Aged
Depression
Depressive Disorder, Treatment-Resistant / physiopathology
Depressive Disorder, Treatment-Resistant / therapy*
Female
Follow-Up Studies
Humans
Inpatients*
Male
Middle Aged
Psychotic Disorders
Recurrence
Remission Induction
Treatment Outcome