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Cited by 45Treatment of Major DepressionBipolar Disorder and TreatmentElectroconvulsive Therapy Studies

Longitudinal course of symptom severity and fluctuation in patients with treatment-resistant unipolar and bipolar depression

Vergunst, Francis K., Fekadu, Abebaw, Wooderson, Sarah C., Tunnard, Catherine S., Rane, Lena J., Markopoulou, Kalypso, Cleare, Anthony J.·2013·Psychiatry Research
DOI 10.1016/j.psychres.2013.03.022
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Abstract

Little is currently known about the long-term course of symptom severity and fluctuation in patients with treatment-resistant depression (TRD). We assessed this using the longitudinal interval follow-up evaluation in 115 patients with TRD (84 unipolar, 31 bipolar) with 1-7 years (median 36 months) of follow-up. Of the follow-up months, 39.2% were spent asymptomatic and 21.1% at sub-threshold symptom level, while 15.8% were spent at mild, 13.9% at moderate, and 10.0% at severe depressive episode level. Significantly more unipolar than bipolar patients were continuously symptomatic during follow-up (43% vs. 29%). Patients had a mean of 1.0 (S.D.=1.2) symptom severity level fluctuations per year. High fluctuating patients had significantly poorer global functioning and quality of life. Although most patients with TRD achieve an asymptomatic state, they continue to fluctuate and experience depressive symptoms in the majority of months, mostly at subclinical or mild severity. However, there are important differences between unipolar and bipolar TRD, with unipolar patients more likely to experience an unremitting depressive state. Additionally, a more fluctuating longitudinal illness course is associated with poorer function and quality of life, and with a bipolar diagnosis. We suggest that the longitudinal illness course is an important outcome to be considered in future TRD research.

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  • The unpredictability of the development of psychiatric disorders and the possibility of long-term remission make it difficult to judge whether the suffering is 'without prospect of improvement'.

    “Moreover, the unpredictability of the development of psychiatric disorders and the possibility of long-term remission, make it difficult to judge whether the suffering is ‘without prospect of improvement’[18–20].”

    From Euthanasia and physician-assisted suicide in patients suffering from psychiatric disorders: a cross-sectional study exploring the experiences of Dutch psychiatrists (2019) · cites this paper as [19]

  • Only social support was a significant predictor of mean symptom severity among tested predictors.

    “Of the tested predictors of mean symptom severity (e.g. social support, number of prior of depressive episodes, duration of admission), only social support was found to be a significant predictor (beta −0.356, p = 0.001).”

    From Irremediability in psychiatric euthanasia: examining the objective standard (2023) · cites this paper as Vergunst et al., 2013

  • Vergunst et al. (2013) found that 60.3% were asymptomatic or at subthreshold level and 39.7% had chronic symptoms at follow-up.

    “The third study showed similar outcomes at follow-up: 60.3% were asymptomatic or at subthreshold level and 39.7% had chronic symptoms (Vergunst et al., 2013).”

    From Irremediability in psychiatric euthanasia: examining the objective standard (2023) · cites this paper as Vergunst et al., 2013

  • These four naturalistic studies showed that a majority of included patients, despite being well-characterized as treatment-resistant at onset and after years of community treatment, significantly improved (reached remission).

    “These studies showed that included patients, despite being well-characterized as treatment-resistant at the onset of the studies and after having received years of community treatment – i.e., persons with extensive psychiatric histories, comparable those requesting and receiving psychiatric EAS currently (Kim, De Vries, & Peteet, 2016; Nicolini, Peteet, Donovan, & Kim, 2020b; Thienpont et al., 201”

    From Irremediability in psychiatric euthanasia: examining the objective standard (2023) · cites this paper as Vergunst et al., 2013

  • Four naturalistic studies focused on medium to long-term outcomes in patients who were explicitly defined as having TRD at beginning of follow-up.

    “Four naturalistic studies focused on medium to long-term outcomes in patients who were explicitly defined as having TRD at beginning of follow-up (Fekadu et al., 2011, 2012; Vergunst et al., 2013; Wooderson et al., 2014).”

    From Irremediability in psychiatric euthanasia: examining the objective standard (2023) · cites this paper as Vergunst et al., 2013

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Authors
Vergunst, F. K., Fekadu, A., Wooderson, S. C., Tunnard, C. S., Rane, L. J., Markopoulou, K., & Cleare, A. J.
Affiliations
King's College London (GB)
Corresponding author
Cleare, Anthony J.
ORCID
Venue
Psychiatry Research
Publisher
Elsevier BV
Published
2013-05
Volume
207
Issue
3
Pages
143-149
ISSN
0165-1781 (ISSN-L)
DOI
10.1016/j.psychres.2013.03.022
OpenAlex
W2143178781
Cited by
45
References
43
Citations by year
2026: 1 · 2025: 6 · 2024: 3 · 2023: 3 · 2022: 4 · 2021: 3 · 2020: 2 · 2019: 4 · 2018: 7 · 2017: 4 · 2016: 4 · 2015: 1 · 2014: 3
FWCI
1.96
Type
journal article
Language
en
Open access
closed
Licence
www.elsevier.com/tdm/userlicense/1.0/ (tdm)
Locations
  • Psychiatry Research (publishedVersion)
  • PubMed (publishedVersion)
  • Research Portal (King's College London) (submittedVersion)
Funders
National Institute for Health and Care Research
Topics
  • Health Sciences › Medicine › Pharmacology › Treatment of Major Depression
  • Health Sciences › Medicine › Psychiatry and Mental health › Bipolar Disorder and Treatment
  • Health Sciences › Medicine › Psychiatry and Mental health › Electroconvulsive Therapy Studies
Keywords
treatment-resistant depression, bipolar depression, major depressive disorder, symptom severity, symptom fluctuation, subclinical depressive symptoms, global functioning, quality of life, depression relapse
MeSH terms
Adult, Antidepressive Agents, Bipolar Disorder, Depressive Disorder, Drug Resistance, Female, Humans, Longitudinal Studies, Male, Middle Aged, Predictive Value of Tests, Psychiatric Status Rating Scales, Severity of Illness Index, Outcome Assessment, Health Care, Disease Progression

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