Prevalence of Treatment Resistant Depression: TRAL study sub analysis in a Mexican sample
Keywords:Mexico, Epidemiology, Treatment-Resistant Depressive Disorder, Major Depressive Disorder, Treatment
Introduction: Epidemiology and burden of disease in LatAm is often scarce in psychiatric disorders. This is particularly relevant in Treatment-Resistant Depression (TRD), a burdensome condition in a significant proportion of Major depressive disorder (MDD) patients. The Treatment Resistant Depression in America Latina (TRAL) study set out to characterize the epidemiology and burden of TRD in MDD patients. This manuscript presents this characterization for the Mexico subset based on data from the TRAL study. Methods: A sample of 697 adult patients clinically diagnosed with MDD were recruited from 14 Mexican sites. Patients with relevant psychiatric comorbidities or enrolled in a clinical trial were excluded. Outcomes were mainly patient reported outcomes and assessment scales. Results: Prevalence of TRD in Mexico was 20.7%. Current suicidality is high in TRD patients (20.8%), as well as suicide behavior disorder (12.5%). SSRIs and SNRIs were the most common medications. Results from EQ-5D, SDS and WPAI show significant limitations for TRD patients in their everyday life. Discussion: Current results are aligned with available literature on treatment and prevalence of suicidality and suicide behavior disorder. The prevalence of TRD in MDD patients is high and presents a management challenge. Conclusions: The burden of TRD in Mexico is significant, although less severe than in other LatAm countries. Public health policies should improve diagnosis and availability of novel more efficacious therapies.
Malhi GS, Mann JJ. Depression. The Lancet. 2018 Nov;392(10161):2299–312.
Storeng SH, Sund ER, Krokstad S. Factors associated with basic and instrumental activities of daily living in elderly participants of a population-based survey: The Nord-Trøndelag Health Study, Norway. BMJ Open. 2018;8(3):1–10.
Xie H, Chen PW, Zhao L, Sun X, Jia XJ. Relationship between activities of daily living and depression among older adults and the quality of life of family caregivers. Frontiers of Nursing. 2018;5(2):97–104.
Castilla-Puentes R, Secin R, Grau A, Galeno R, Feijo de Mello M, Pena N, et al. A multicenter study of major depressive disorder among emergency department patients in Latin-American countries. Depress Anxiety. 2008;25(12):E199-204.
Mrazek DA, Hornberger JC, Altar CA, Degtiar I. A Review of the Clinical, Economic, and Societal Burden of Treatment-Resistant Depression: 1996–2013. Psychiatric Services. 2014;65(8):977–87.
Hasin DS, Sarvet AL, Meyers JL, Saha TD, Ruan WJ, Stohl M, et al. Epidemiology of adult DSM-5 major depressive disorder and its specifiers in the United States. JAMA Psychiatry. 2018;75(4):336–46.
Gaynes BN, Warden D, Trivedi MH, Wisniewski SR, Fava M, Rush AJ. What Did STAR*D Teach Us? Results From a Large-Scale, Practical, Clinical Trial for Patients With Depression. Psychiatric Services. 2009 Nov;60(11):1439–45.
Conway CR, George MS, Sackeim HA. Toward an evidence-based, operational definition of treatment-resistant depression: When Enough is enough. JAMA Psychiatry. 2017;74(1):9–10.
Thase M, Connolly R. Unipolar depression in adults: Choosing treatment for resistant depression - UpToDate [Internet]. UpToDate. 2019 [cited 2019 Aug 14]. Available from: https://www.uptodate.com/contents/unipolar-depression-in-adults-choosing-treatment-for-resistant-depression#H925759895
Kraus C, Kadriu B, Lanzenberger R, Zarate CA, Kasper S. Prognosis and improved outcomes in major depression: a review. Transl Psychiatry. 2019;9(1).
Johnston KM, Powell LC, Anderson IM, Szabo S, Cline S. The burden of treatment-resistant depression: A systematic review of the economic and quality of life literature. J Affect Disord. 2019;242(June):195–210.
Lepine BA, Moreno RA, Campos RN, Couttolenc BF. Treatment-resistant depression increases health costs and resource utilization. Revista Brasileira de Psiquiatria. 2012 Dec;34(4):379–88.
Chow W, Doane MJ, Sheehan ; Jack, Alphs L, Le H. Economic Burden Among Patients With Major Depressive Disorder: An Analysis of Healthcare Resource Use, Work Productivity, and Direct and Indirect Costs by Depression Severity. Am J Manag Care. 2019;
Soares B, Kanevsky G, Teng CT, Pérez-Esparza R, Bonetto GG, Lacerda ALT, et al. Prevalence and Impact of Treatment-Resistant Depression in Latin America: a Prospective, Observational Study. Psychiatric Quarterly [Internet]. 2021 Aug 31; Available from: https://link.springer.com/10.1007/s11126-021-09930-x
Sheehan D V., Lecrubier Y, Sheehan KH, Janavs J, Weiller E, Keskiner A, et al. The validity of the Mini International Neuropsychiatric Interview (MINI) according to the SCID-P and its reliability. European Psychiatry. 1997;12(5):232–41.
Montgomery SA, Asberg M. A new depression scale designed to be sensitive to change. British Journal of Psychiatry. 1979;134(4):382–9.
Kessler RC, Bromet EJ. The epidemiology of depression across cultures. Annu Rev Public Health. 2013;34:119–38.
Jaffe DH, Rive B, Denee TR. The humanistic and economic burden of treatment-resistant depression in Europe: a cross-sectional study. BMC Psychiatry. 2019;19(1):1–11.
Ivanova JI, Birnbaum HG, Kidolezi Y, Subramanian G, Khan SA, Stensland MD. Direct and indirect costs of employees with treatment-resistant and non-treatment-resistant major depressive disorder. Curr Med Res Opin. 2010;26(10):2475–84.
Zhang Q, DiBernardo A, Heerlein K, O’Hara M, Benson C, Gonzalez Martin Moro B, et al. Association of Treatment Resistant Depression with Healthcare Resource Utilization and Physician Satisfaction with Disease Management. Value in Health. 2018 May;21:S188.
Guerra M, Ferri CP, Sosa AL, Salas A, Gaona C, Gonzales V, et al. Late-life depression in Peru, Mexico and Venezuela: The 10/66 population-based study. British Journal of Psychiatry. 2009;195(6):510–5.
Borges G, Benjet C, Medina-Mora ME, Orozco R, Wang PS. Treatment of mental disorders for adolescents in Mexico City. Bull World Health Organ. 2008;86(10):757–64.
Pimentel L. The Importance of Mental Health in the Mexican Public Health System. Mexican Journal of Medical Research ICSA. 2019;7(13):1–6.
Kohn R, Ali AA, Puac-Polanco V, Figueroa C, López-Soto V, Morgan K, et al. Mental health in the Americas: an overview of the treatment gap. Revista Panamericana de Salud Pública. 2018;42:1–10.
Martinez W, Galván J, Saavedra N, Berenzon S. Barriers to integrating mental health services in community-based primary care settings in Mexico city: A qualitative analysis. Psychiatric Services. 2017;68(5):497–502.
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Copyright (c) 2022 Instituto Nacional de Neurología y Neurocirugía Manuel Velasco Suárez
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September 2022-present © Instituto Nacional de Neurología y Neurocirugía Manuel Velasco Suárez. Open access articles under the terms of the Creative Commons Attribution-NonCommercial 4.0 International (CC BY-NC 4.0) license, which permits use, distribution and reproduction in any medium, provided the original work is properly cited. No commercial re-use is allowed.
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January 2014-December 2021 © Instituto Nacional de Neurología y Neurocirugía Manuel Velasco Suárez. Open access articles under the terms of the Creative Commons Attribution 4.0 International (CC BY 4.0) license, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.