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Prognosis and improved outcomes in major depression: a review

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Kraus, Christoph, Kadriu, Bashkim, Lanzenberger, Rupert, Zarate, Carlos A., Kasper, Siegfried·2019·Translational Psychiatry
DOI 10.1038/s41398-019-0460-3PMC PMC6447556
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Abstract

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. This literature review sought to investigate factors closely linked to outcome and summarize existing and novel strategies for improvement. 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. Potential biomarkers have been explored, including hippocampal volumes, neuronal activity of the anterior cingulate cortex, and levels of brain-derived neurotrophic factor (BDNF) and central and peripheral inflammatory markers (e.g., translocator protein (TSPO), interleukin-6 (IL-6), C-reactive protein (CRP), tumor necrosis factor alpha (TNFα)). However, their integration into routine clinical care has not yet been fully elucidated, and more research is needed in this regard. Genetic findings suggest that testing for CYP450 isoenzyme activity may improve treatment outcomes. Strategies such as managing risk factors, improving clinical trial methodology, and designing structured step-by-step treatments are also beneficial. Finally, drawing on existing guidelines, we outline a sequential treatment optimization paradigm for selecting first-, second-, and third-line treatments for acute and chronically ill patients. Well-established treatments such as electroconvulsive therapy (ECT) are clinically relevant for treatment-resistant populations, and novel transcranial stimulation methods such as theta-burst stimulation (TBS) and magnetic seizure therapy (MST) have shown promising results. Novel rapid-acting antidepressants, such as ketamine, may also constitute a paradigm shift in treatment optimization for MDD.

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  • Meta-analyses and systematic reviews have described initial symptom severity, personality characteristics, heredity, childhood stressful events, neurophysiological markers, and genetic determinants as possible predictors of psychotherapy outcome in anxiety and depressive disorders.

    “В метаанализах и систематических обзорах в качестве возможных предикторов исхода психотерапии тревожных и депрессивных расстройств описаны изначальная тяжесть клинических симптомов [7-9], личностные характеристики пациентов [10], насле дственность [8], стрессовые события в детстве [9], нейрофизиологические маркеры [9, 11], генетические детерминанты [9].”

    From Positive-Dialogue Psychotherapy Outcome Predictors in Patients with General Anxiety Disorder and Mixed Anxiety and Depressive Disorder (2024) · cites this paper as [9]

    The review’s “Prognostic variables for treatment outcomes in MDD” section discusses baseline severity, childhood maltreatment, neuroimaging markers, and candidate genes as possible predictors; its discussion of severity notes mixed findings. It concerns treatment outcomes in major depressive disorder, often specifically antidepressant treatment, rather than psychotherapy outcomes across both anxiety and depressive disorders. Page numbers are unavailable in our copy. (LLM, conf=0.87)

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Cited by

Sorted by citations

Authors
Kraus, C., Kadriu, B., Lanzenberger, R., Zarate, C. A., & Kasper, S.
Affiliations
  • National Institutes of Health (US)
  • Medical University of Vienna (AT)
Corresponding author
Kasper, Siegfried
ORCID
Venue
Translational Psychiatry
Publisher
Springer Science and Business Media LLC
Published
2019-04-03
Volume
9
Issue
1
Pages
127-127
ISSN
2158-3188 (ISSN-L)
DOI
10.1038/s41398-019-0460-3
PMC
PMC6447556
OpenAlex
W2934413595
Cited by
482
References
48
Citations by year
2026: 48 · 2025: 80 · 2024: 64 · 2023: 72 · 2022: 88 · 2021: 70 · 2020: 54 · 2019: 6
FWCI
7.00
Type
journal article
Language
en
Open access
Licence
Locations
  • Translational Psychiatry (publishedVersion, cc-by)
  • Europe PMC (PubMed Central) (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion)
Funders
Intramural Research Program at the National Institute of Mental Health, National Institutes of Health
Topics
  • Health Sciences › Medicine › Pharmacology › Treatment of Major Depression
  • Life Sciences › Neuroscience › Neurology › Transcranial Magnetic Stimulation Studies
  • Health Sciences › Medicine › Psychiatry and Mental health › Electroconvulsive Therapy Studies
Keywords
major depressive disorder, treatment outcomes, prognosis, comorbidities, biomarkers, hippocampal volume, anterior cingulate cortex, brain-derived neurotrophic factor, inflammatory markers, treatment-resistant depression, electroconvulsive therapy, transcranial magnetic stimulation, ketamine, rapid-acting antidepressants
MeSH terms
Antidepressive Agents, Depressive Disorder, Major, Major Depressive Disorder, Electroconvulsive Therapy, Humans, Psychotherapy, Randomized Controlled Trials as Topic, Treatment Outcome, Practice Guidelines as Topic, Genome-Wide Association Study, Neuroimaging

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