Factors associated with pharmaco resistance in major depressive disorder

Depressive disorder is a common psychiatric disorder that represents a major public health problem. The failure of pharmacological treatment remains frequent, resulting in significant socio-professional disability and high economic costs. The objective of our work was to specify the rates of resistance and remission under antidepressants and to determine the factors associated with drug resistance in this disorder.

It was a prospective, longitudinal, analytical study conducted in the psychiatry department of the Military Hospital of Tunis in patients consulting for a depressive disorder. The participants were put on antidepressants with a regular evaluation of the response to the treatment through the Hamilton depression scale. The absence of response after two successive antidepressants was considered as resistance to antidepressant treatment.

Our study included 80 patients, of whom 13 were excluded and 67 completed the study. The mean age of the final sample was 42.2 years with a slight male majority of 56.7%. The resistance rate was 28.4%. There was a significant association of the resistant character of the depression with the following factors: severity of the depressive episode (p<0.001), duration of the depressive symptomatology (p=0.026), belonging to a military family (p=0.009), presence of a non-addictive psychiatric comorbidity (p=0.005), particularly an anxiety disorder (p=0.003) and the presence of a post-traumatic stress disorder (p=0.007).

This study underlines the importance of early and adequate management of resistant depression, which remains frequent. There are many predictive factors that must be detected at an early stage in order to adapt therapeutic strategies.