Characteristics of desipramine-refractory depression

To determine the predictors of desipramine-refractory depression, the authors examined the outcome in patients with major depression who were admitted to a general hospital and treated with desipramine adjusted to an adequate blood level.

Sixty-eight consecutive inpatients with DSM-III nonpsychotic unipolar major depression who had failed to respond to 1 week of hospitalization without drug treatment were studied. Outcome was assessed with the Yale Depression Inventory after a 4-week desipramine trial in which 24-hour plasma concentrations were used to rapidly achieve a therapeutic desipramine level.

Poor response to a therapeutic desipramine trial, which occurred in 15 of 50 patients, was significantly associated with definite personality disorder, prior treatment failure, near delusional status, age < or = 35 years, duration of depressive episode, recurrence of depression, dysthymia, and secondary depression. The first four items remained significantly correlated with poor response when the presence of the other items was accounted for using multiple regression. Drug response was not predicted by the diagnosis of melancholia (DSM-III and DSM-III-R) or initial severity of the depressive episode.

The four strongest correlates of outcome were highly predictive of drug response. In patients with two or more predictors, only 25% (4 of 16) responded, while in those with one or no predictors, 91% (31 of 34) responded.