What are the factors that predispose patients to treatment-resistant depression?
What are the advances that predict antidepressant treatment response for depression?
Two articles about prediction of antidepressant treatment response by using artificial intelligence technology and machine learning algorithms:
- An electroencephalographic signature predicts antidepressant response in major depression (doi:10.1038/s41587-019-0397-3)
- Brain regulation of emotional conflict predicts antidepressant treatment response for depression (doi:10.1038/s41562-019-0732-1)
According to the people traits. Some people get better by using antidepressants. However, some others do not response to this medicine.
As we know depression disorder follows biopsychosocial model which means that many factors affect its course and only 70 % responce to drugs due to the variations in their biological, psychological and social factors and also treatment is not only depends on drugs.
Antidepressants affect the symptom of depression - a deficiency of neurotransmitters. The primary cause of depression remains and usually progresses actively. With the help of antidepressants, we create the false impression of a complete cure for the disease. Prescribing antidepressants (household antidepressant - alcohol); rapid removal of acute symptoms of depression. The constant or uncontrolled use of antidepressants has the same negative consequences as alcohol abuse. The cause of depression does not disappear when we try to overcome the symptom of depression - a deficiency of neurotransmitters by artificial saturation of the brain with some neurotransmitters. A shortage of neurotransmitters signals us that the body is not working properly. It is necessary to eliminate the primary cause of depression - to fulfill the primary irreplaceable needs of the body, ignoring which is the cause of depression.
It has not been shown consistently that some patients "respond" better to antidepressants than others. This may be a statistical illusion. Possibly, all patients have a very similar (nearly non-existent) benefit from ADs. See here: Preprint On the treatment effect heterogeneity of antidepressants in ...
Therefore, the search for predictors of response may be futile.
Regarding the above-mentioned paper on response-prediction via EEG: If I see this replicated in 2-3 independent studies, I may start to believe the result.
For now: Highly unlikely to be true (my personal opinion, based on 1.000s of examples in the past).
It depends on the diagnosis of patients and the duration of treatment.
According to the people traits. Some people get better by using antidepressants. However, some others do not response to this medicine.
Antidepressants do not treat depression in the usual sense of the term "treatment of the disease", as depressive processes do not stop, or turn into a latent chronic form. With the help of antidepressants, they try to artificially restore the necessary balance in the brain, while ignoring the initiating process of depression. Deficiency of neurotransmitters is not a disease, but is a reflection of the state of the body, is an incentive to respond. Therefore, if we simply change the balance of neurotransmitters, the state of the processes initiating depression in the body does not change. The deficit of neurotransmitters is not regulated by artificial restoration of balance, since the balance of neurotransmitters depends on the processes of initiators.
Hi every body,
It is not the whole truth that antidepressants don't help some patients.
Let's see what is treatment guideline/s of depression. First measure in the line of treatment is Psychological intervention in the form of CBT/REBT/Psycho education/ brief psychotherapy/psychoanalytical psychotherapy, etc. Second line of treatment is Pharmacotherapy.
So if a clinician/psychiatrist is offering only pharmacotherapy then in some cases results may be delayed.
Reasons behind such delay or incomplete recovery or relapses are many.
Foremost & first in the order is relapsing nature of this disorder!
Other reasons can be accommodated under the heading of clinical pharmacological, co-morbid conditions like compliance of patient, OC features, defense mechanisms of patient, family conditions, and so on so forth. This list is quite long & vary from subject to subject.
The recurring nature of depression is a sign that psychological intervention and pharmacotherapy only manipulate the symptom of depression. Depression is a natural reaction, an incentive for the body to perform the necessary response actions. When we feel hunger, we do not conduct psychotherapy sessions to reduce hunger. When we are hungry, we do not take drugs that reduce the feeling of hunger, but eat something. Therefore, a reaction to depression in the form of psychological intervention or pharmacotherapy is an unnatural reaction. An unnatural reaction to an irritant will not have a result. Therefore, an unnatural reaction to depression shows a relapsing character, and the effect of antidepressants has a limited temporary effect on depression or does not affect depression.
Dear All,
Depression is very much an organic disease of brain. It means; physiological, neurotransmitter-wise, neurological (sluggish neuron-transmission), genetic disease which is vulnerable to psychological & social impacts.
Depression diagnosed on the basis of DSM VI/V or other classifications.
Depression is commonly diagnosed by psychiatrist and at some places by clinical psychologist.
Feeling depressed or feeling low, or feeling nervous as a result of inner or external reasons is not synonymous to diagnosis of depression. E.g. During menstrual period female/s feel depressed but that does not mean that they are then suffering from depression. Similarly any bad or undesired event can bring depressed feeling; such circumstances do not mean a disease called depression.
Dr. Madhav Raje
Psychiatrist.
I agree with you doctor.... Symptom of depression doesnt mean having the depressive disorder..... And it can occur in many disorders( psychiatric or Medical).
Depression is not a genetic disease. There are publications available that refute the thesis of a genetic predisposition to depression. A set of genes inherent in depression was not found. A feature of the mechanism of modern depression is that elements of depression are present at every moment in people of all ages. This is the physiological feature of modern depression. Therefore, the woman’s menstrual cycle and teenage transition and other stresses act as triggers of depression. There will always be an element of depression for any stress. Along with the presence of triggers, there is "depression for no reason." Based on the properties of the cause of depression, we can talk about the presence of elements of depression in 99% of the population. Everyone has elements of depression. In modern conditions, there are no people who would not have elements of depression. Everyone has a depression at some stage of development. But knowledge of the formula for depression makes it easy to eliminate. Any stress in 99% of the population can detect and stimulate depression. A unique feature of modern depression is its total prevalence. If everyone is gradually ill with the coronavirus, then the peculiarity of depression is that it is present in open or latent form constantly in 99% of the population. Therefore, any stress always stimulates depression. Depression is a total disease, but can be eliminated with the help of techniques that correct some physiological processes in the body. Microprocesses for the development of depression are very complex and therefore the study of these processes does not give a result. But there is also life without depression. This is when the stress stream is quickly processed and there are no stuck stresses in the stress queue. This is ensured by the elimination of disturbances in the work of responsible physiological processes.
Any psychiatric disease like depression to become clinically detectable essentially needs biological attributes; such attributes invariably originate from genetic predisposition. This causal factor is named in general language as genetic. Genetic causes among psychiatric diseases do not manifest like that of diabetes. foF exam. if diabetes if parent/s have diabetes any child can have diabetes. But if parent have depression then it is not necessary that any child would have depression itself; that child may suffer from any other psychiatric disorder/s like Ocd. In such case; that Ocd is said to have genetic trail from parents. This is how genetic predisposition manifest in case of psychitric diseases.
However it must be remembered that only genetic cause is not sufficient for manifestation of any psychitric diseases.
Any psychitric disease like depression all three factors, i.e. biological, psychological and social attributes to gather influence manifestation of that disease.
No psychitric disorders is caused by single causal factor and no single theory can explain it's attributes to the fullest extent.
🙂
In continuation to my first response I would like to add second factor which predisopes treatment resistant depression. First factor was
1) Relapsing nature of depression.
2) Irregular treatment. This irregularity in treatment can take place in both forms i.e. psychotherapy and pharmacotherapy. Any therapy if discontinued without doctor's consent even if patient experience total relief even then possibility of recurrence cannot be ruled out.
Gradual tapering of Medicine is strictly followed to avoid relapse.
It is mentioned in text books of psychiatry that if relapse occur once then treatment should be continued despite symptomatic relief at least for 3-4 years, if relapse occur twice then treatment should be taken for 8-9 years approx, and if relapse occur 3 or more than 3 the times then possibility of continuation of treatment for many years cannot be ruled out.
One must remember that psychiatric diseases are full of possibilities. 🙂
So patient, doctors and relatives or careers need to exercise lot of flexibility.
Decisiona can change from case to case; any one line of action may not be applicable for other.
🙂
I suspect false positives may be behind some drug failures.
Placebo effect is always with us.
This can be exacerbated by the drugs possibly having a minor effect that is quickly dissipated by tolerance.
Some patients will discontinue efforts to identify effective medicines because they're unfamiliar with the concept of antidepressant classes. They may be offered three different kinds of SSRIs and then refuse further medicine candidates because they have tried three and none worked, never having tried SNRIs, MAO Inhibitors, Tri-cyclic Antidepressants, or an atypical like bupropion. To try just one class of anti-depressant and say depression is resistant would be not wholly accurate.
Finally, confounding factors may include interpersonal problems that wax and wane as well as talk therapy that may improve or worsen conditions independently of teh drug and yet improvement and failure may be misattributed to varying degrees.
According to article -
A Review of the Conceptualisation and Risk Factors Associated with Treatment-Resistant Depression (doi: 10.1155/2017/4176825)
Many factors have been associated with TRD such as inflammatory system activation, abnormal neural activity, neurotransmitter dysfunction, melancholic clinical features, bipolarity, and a higher traumatic load.
Also in the article there is a table that Summary of the biological, psychological, genetic, and clinical correlates of TRD:
Article A Review of the Conceptualisation and Risk Factors Associate...
I think it can be important that immun activation for treatment resistant depression.
"An increase in proinflammatory cytokines has been associated with HPA axis disturbance and is thought to lead to the release of the stress-hormone, cortisol."
The massive depression that is now prevalent in the world is due to one causative factor - the lack of satisfaction of an important physiological need similar to the need for heat or the need for food. If you are hungry or cold, what are the main causes of hunger or cold? You can consider the genetic predisposition to cold and hunger, you can consider the social factors of cold and hunger or biological factors. But the main reason that you are hungry will be that you did not eat. If you are cold, it means that you are in the cold without clothes, you need to wear warm clothes or go into a warm room. If you do not eat or in cold weather without clothes, this will lead to stress and illness. Depression is a normal reaction of the body. A normal reaction is also a feeling of cold, a feeling of heat, a feeling of hunger. To diagnose hunger or cold, we do not expect clinical signs of hunger and cold when destructive changes in the body begin. Following the feeling of hunger we eat, if it is cold, then we dress warmly. Likewise, it is not necessary to expect clinical signs of depression when the psyche is disturbed or a chronic process forms. It is necessary to resolve the process that caused depression. Clinical signs of depression are a severe chronic process that has not been resolved for a long time. To diagnose hunger, we do not wait for the clinical signs of anorexia, to diagnose a feeling of cold, we do not expect frostbite in order to understand that we are freezing. In the case of depression, it is also not necessary to bring to clinical signs of depression - "mental anorexia" or "mental frostbite" to understand that it is depression. The clinical signs of depression, as well as signs of hunger and cold - anorexia and frostbite, this is the beginning of organic decay, a chronic process and this can be avoided.
Depression has a relapsing nature, as with the help of medications the balance of neurotransmitters is temporarily changed. But the source of depression remains and is actively working. With medicines, the necessary balance of neurotransmitters is temporarily replaced by another set of neurotransmitters. But the problem of depression remains. With continued treatment with medications, chronic processes occur, since the problem remains unresolved. Relapse means that the problem is not solved, when the replacement is removed, then relapse occurs. Substitution is not a substitute for the natural balance of neurotransmitters and has side effects. The need for constant medication (even lifelong administration) is also a sign that only symptoms of depression are being exploited. The physiological nature of depression is ignored, the physiological processes leading to depression are ignored, the processes are brought to the onset of clinical symptoms, and then symptoms are treated. The failure to treat depression is not in the irregular treatment of symptoms of depression (which, if treated with psychotherapy and medications, still appear because the source of depression is actively working), but in ignoring the normal physiological reactions of the body, which then turn into chronic, until the onset of clinical symptoms .
Trying to treat hunger with medications that create a feeling of satiety or block the feeling of hunger is not the best option to be healthy. Depression is a reflection; it is not a destructive process itself. It is necessary to treat not depression, but the process that causes depression. When journalists write about some kind of problem, we are treating not the journalists, but the problem that the journalists wrote about. In the event of depression, try to treat journalists, not a problem.
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