Intractable Depression

"One of the most prevalent psychiatric disorders encountered by primary care physicians in Canada [hard-to-treat depression]."
"These findings emphasize the persistence of depressive symptoms in a large proportion of patients with MDD [major depressive disorder]."
Canadian Journal of Psychiatry -- new Canadian study

"Every time there is a tragedy in the public domain it causes people to revisit an ongoing story -- and that is that depression has an enormous impact on the lives of Canadians."
"It kills a substantial number of Canadians every year."
Dr. Sidney Kennedy, professor of psychiatry, University of Toronto

Dr. Kennedy, who holds the Arthur Summer-Rotenberg chair in suicide studies at University of Toronto is the lead author in a study reviewing the high rates of severely depressed patients who don't respond to the protocols of common treatments. This increases their risk of developing crippling depression. It is the kind of depression linked to the death by suicide of American actor-comic Robin Williams who was plagued for many years by his own bouts of MDD.

Roughly 11-percent of Canadians meet medical criteria for major depressions at some time in their lives. Many depressed people may think about taking their own lives, but most don't follow through on the impulse. In treatment-resistant depression people are afflicted with repeated incidents of what appears like paralyzing depression. And they report a large incidence of side effects from the use of antidepressants, ranging from dizziness, confusion, tremors, rapid heartbeat, weight gain and sexual dysfunction.

Not entirely surprising since there are always side-effects of some kind, from mild to threatening with the use of drugs, and the knock-on effect (iatrogenic effect) often results in having to treat symptoms caused by an initial drug intake with other, remediating drugs. In the study that Dr. Kennedy and his colleagues undertook, patients who exhibited no, or minimal improvement in their symptoms after two or more trials with different classes of antidepressants over a minimum of six weeks were considered to be treatment-resistant.

"Once you get to that level of severity you're at greater risk of recurrences, you're at greater risk of medical complications and the risk of suicide is increased", advised Dr. Kennedy. Of 1,212 patients in which 135 family doctors across Canada participated, reviewing charts from ten of their last consecutive patients treated for major depression for each doctor, 263 of the total fell into the classification of treatment-resistant.

Those identified as treatment-resistant tended to be identified as older (50s), likelier on long-term disability, more prone to report signs of substance abuse, and anxiety, and tending to be on multiple drugs including anti-psychotics. They also tended to be overweight or obese. Dr. Kennedy recommended that doctors seeing patients with treatment resistant depression should make an effort to screen for other diagnoses such as bi-polar disorder.