Discrepancy between subjective and objective severity in treatment-resistant depression Prediction of treatment outcome

Objective Identifying predictors of outcome among patients with treatment-resistant depression (TRD) is challenging We hypothesised that discrepancy between self-rated and observer-rated scales may be a simple way of making such a prediction Method 102 patients were admitted to a unit specialising in the treatment of resistant depression and underwent fortnightly assessment with clinician-rated (Hamilton Depression Rating Scale-21 HAM-D) and self-rated (Beck Depression Inventory BDI) measures All patients had significant depressive symptoms that were treatment resistant 70% as part of a major depressive disorder and the remainder as part of a bipolar or other disorder A discrepancy score between the HAM-D and BDI was calculated on admission and its association with patient clinico-demographic factors was determined A subset of 67 patients remained as inpatients for 40 weeks or until clinical response and were entered into a responder analysis in which response was defined as >= 50% reduction in admission HAM-D score The association of the admission BDI-HAM-D discrepancy score with subsequent patient response was determined Results The magnitude of BDI-HAM-D discrepancy was higher in those with co-morbid personality disorder lower in those with psychosis and positively correlated with anxiety High BDI-HAM-D discrepancy score predicted delayed treatment response (odds ratio 5 40 p = 0 005) Conclusion Within TRD higher discrepancy predicts slower response to treatment independent of objective illness severity this may be mediated by underlying personality traits and co-morbid anxiety (C) 2010 Elsevier Ltd All rights reserved