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Thursday, September 22, 2022

Depression Treatment Failure Burdens Patients' Life and Wallets

 Depressed patients with prior treatment failure often face high medical costs and poor quality of life, a new survey suggested.

Of 10,710 adults with self-reported major depressive disorder (MDD) who participated in the 2019 National Health and Wellness Survey, 1,077 said they experienced treatment failure requiring them to try new medications as a result of non-responsiveness, Larry Culpepper, MD, of Boston University School of Medicine, and colleagues reported at Psych Congress 2022.

Among these patients who experienced depression treatment failure, many reported low quality of life and high medical costs.

However, those with more severe cases of depression tended to carry more of these burdens. For example, in a comparison of scores from three quality-of-life measures, those with severe major depressive disorder saw significantly lower marks compared with those with milder disease:

  • Short Form (SF)-36v2 mental component: 21.8 points for severe MDD vs 42.3 for mild MDD
  • SF-36v2 physical component: 43.9 points for severe MDD vs 47.8 for mild MDD
  • EuroQol 5-Dimension Visual Analogue score: 45.3 points for severe MDD vs 67.6 for mild MDD

On top of that, patients with severe MDD who experienced prior treatment failure also faced significantly higher direct and indirect medical costs. Patients with mild MDD with prior treatment failure saw average direct medical costs -- including factors like emergency department visits, healthcare provider visits, and hospitalizations -- of $9,447 on average. These direct medical costs increased to $10,428 for moderate MDD, dropped slightly to $8,673 for moderate-severe MDD, but then topped off at $13,971 for severe MDD.

These direct medical costs were calculated by multiplying the average unit cost, as reported by the Medical Expenditure Panel Survey, by the number of each type of visit.

Average indirect medical costs -- including factors such as the cost of presenteeism and absenteeism at work -- followed a similar pattern:

  • $3,027 for mild MDD
  • $4,985 for moderate MDD
  • $5,131 for moderate-severe MDD
  • $7,271 for severe MDD

Indirect costs were calculated by taking the number of work hours missed due to health (representing absenteeism) plus the number of work hours with decreased productivity because of health problems (representing presenteeism) and multiplying these by median hourly wages set forth by the Bureau of Labor Statistics.

"The key takeaway from this analysis was that among patients who report a prior treatment failure, there is a high humanistic burden in terms of poor health-related quality of life as well as high direct medical and indirect costs," Mousam Parikh, MSc, director of health economics outcomes research for psychiatry at AbbVie, who presented the results, explained to MedPage Today.

"This data analysis reinforces the need to routinely monitor patient-centric outcomes such as health-related quality of life and work productivity impacts among patients with a prior failure to MDD treatment, regardless of disease severity," she added.

Although the researchers weren't necessarily surprised by the findings, given the fact that MDD is often "a significant burden" on the healthcare system, Parikh said they "were surprised by the high humanistic and economic burden for patients with mild MDD who self-reported a prior treatment failure."

"Given that patients with MDD may often cycle through different treatment options over the course of their disease journey, these results reflect the considerable unmet need experienced by these patients," she pointed out.

Parikh also highlighted that it's still important to recognize that even those who experienced treatment failure for just mild MDD reported poor outcomes.

"Additionally, the high proportion of patients in this analysis reporting a comorbidity of anxiety disorder emphasizes the need for early effective therapy as these patients could have poorer patient outcomes compared to patients without comorbid mental health disorders," she noted.

Across the range of MDD severity, comorbid anxiety was quite common, affecting:

  • 62.7% of those with mild MDD
  • 77.9% of those with moderate MDD
  • 81.3% of those with moderate-severe MDD
  • 87.6% of those with severe MDD

Beyond anxiety, patients with treatment-failure MDD tended to see a high rate of many comorbidities, including panic disorder, phobias, post-traumatic stress disorder, social anxiety, attention deficit disorder, and obsessive-compulsive disorder.

All respondents to the survey were U.S. residents ages 18 and older. MDD was defined as a self-reported physician diagnosis for depression, and those with bipolar I disorder or schizophrenia in the past 12 months were excluded.

Of this cohort, 48% had mild MDD (Patient Health Questionnaire-9 score of 0-9), 22.66% had moderate MDD (score of 10-14), 17.36% had moderate-severe MDD (score of 15-19), and 11.98% had severe MDD (score of 20 or above). More white patients had mild than severe disease (84.3% vs 74.4%), while Black patients were more likely to have severe MDD (3.1% vs 7.8%), the researchers reported.


The study was funded by AbbVie.

Culpepper reported several disclosures, including a relationship with AbbVie.

Primary Source

Psych Congress 2022

Source Reference: Culpepper L, et al "Health-related quality of life and costs associated with major depressive disorder in patients with prior treatment failure" Psych Congress 2022; Poster 121.


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    Depression treatment failure, what if biomarkers existed that often predicted why treatment outcomes succeed or fail and a polypharmacy of drugs that might provide a panacea for many insults and illnesses. It has long been hypothesis BUT never tested by straightforward and available science methods for drug R&D. Not of much academic or corporate interest, NO big money or great glory in generic drugs, science selected supplements, underpinned with good diet and lifestyle. Further whether depression or long COVID immune activation-dysfunction neuroimmunology may take time, even years to ameliorate.

    Good article to start, there is much more if you search [depression inflammation].

    The Role of Inflammation in Depression and Fatigue. https://www.ncbi.nlm.nih.go...

    Many drugs, peptides and compound to include many neurotropic drugs have secondary pleotropic anti-inflammatory action. The nervous and immune systems are evolutionarily integrated some cytokines and other immunomodulator and neurotransmitter e.g. IL-1, PAF, have dual functions in both systems. This is reflected in the field of neuroimmunology for many decades and Immunopsychiatry for over a century. I have published on the use of anti-inflammatory on-label and "repurposed" pleotropic drugs and compounds, especially in synergy, multi-threat medical countermeasures [search term] to treat many insults and pathology.

    We can do the research on dual systems and pleotropic countermeasures or continue to pretend it's all in your head.

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        That the researchers "were surprised by the high humanistic and economic burden for patients with mild MDD who self-reported a prior treatment failure" is horrifying but to be expected. (byw, "humanistic" is misused in that sentence; being clinically depressed has little to do with humanism; correct language matters.) Much of this article reports how research into not-entirely-physical illness is biased. It's biased toward things that can be measured and learned about by the use of statistics. But depression is "subjective"; instances of it have to be protected from seeming merely "anecdotal" by being forced into unhelpful categories. Who determines "severe"? what does "mild" mean? Why is a depressed patient's concurrent anxiety considered a comorbidity instead of part of the same illness? The same goes for PD, PTSD, OCD, ADD, et al. Sure, it costs almost $600 for an emergency-room visit where I live, but what does that fact add to our knowledge of what depressed people are experiencing or what can and should be done to alleviate their suffering? Moreover, if a patient works for a good employer, missing work costs her nothing in money, but otherwise the high-salary patient's loss of income must count "objectively" as more than the patient whose job pays $14/hour, whose loss of income is relatively greater in the context of her smaller budget).

        It's nice to know depression is the focus of research. It would be nicer if the research actually helped depressed patients. It would be nicer still if there were a cataclysmic revolution in our culture's whole approach to mental and emotional health.


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