Prevalence & Characteristics Of Treatment Resistant Depression Amongst Adolescent Youth In An Outpatient Psychiatric Setting

Prevalence & Characteristics Of Treatment Resistant Depression Amongst Adolescent Youth In An Outpatient Psychiatric Setting

Pentz J; Bilge-Johnson S; Cannon K; McNinch N; Shauver L; West M

Journal of Medical Sciences at NEOMED

2024

BACKGROUND: Adolescent depression is a prevalent psychiatric illness, with recent data showing that 16.4% of youth ages 12-17 in the United States experienced at least one episode of major depressive disorder (MDD) in 20226. MDD in adolescents is associated with suicidal behavior, substance use, and significant impairments in psychosocial functioning1. The American Academy of Child and Adolescent Psychiatry’s practice parameters recommend pharmacologic intervention with antidepressant medicine for children and adolescents who do not respond to supportive psychotherapy, or those who have more complicated depression2. Antidepressant medicines such as selective serotonin reuptake inhibitors (SSRIs) have been shown to be effective for many adolescents, however, around 40% of patients remain depressed despite first-line pharmacologic intervention5. Around half of these adolescents have remission of depression after antidepressant medicine is switched to an alternative agent and psychotherapy is added, leaving around one-fifth of adolescents, who do not respond to conventional interventions3. Individuals who fail to respond to two trials of first-line pharmacological therapy are often considered to have “treatment-resistant depression” (TRD)4. Interventional treatments such as ketamine and TMS show promise as adjunctive or alternative treatments for depressed adolescents. However, the implementation of interventional therapies does require unique medical infrastructure to facilitate these modalities of treatment. In order to justify the investment in medical infrastructure in a hospital setting, an examination of the potential demand for interventional treatments is warranted. To assess the potential demand for interventional therapeutics at Akron Children's Hospital, it is necessary to evaluate the proportion of outpatients who would meet the criteria for treatment-resistant depression. STUDY PURPOSE: The primary aim of this study is to quantify and characterize the population of outpatients seen at Akron Children’s Hospital ages 12 - 17 years who meet the criteria for major depression. By evaluating the quantity of antidepressant medication trials per patient as well as the severity of MDD episode(s), the authors hope to illustrate the degree of “treatment resistance” that exists amongst depressed adolescents in the outpatient psychiatric population. METHODS: Psychiatric outpatients at Akron Children's Hospital were retrospectively reviewed, including EMR data from January 2023 to January 2024. ICD-10 codes for major depressive disorder were entered into a search query to identify the total number of outpatient individuals diagnosed with MDD. Among patients diagnosed with a major depressive disorder, the severity of MDD was scrutinized by stratifying diagnoses into categories of mild/remitted, moderate, and severe depression. Finally, the number of antidepressant trials was assessed for patients diagnosed with MDD. RESULTS: Among 5740 psychiatric outpatients at Akron Children's Hospital, 1214 (21.1%) were found to have a diagnosis of major depressive disorder. Among this group of patients diagnosed with MDD, 127 (10.5%) were found to have a diagnosis of mild or remitted depression, 750 (61.2%) showed moderate symptoms of depression, and 337 (27.8%) were characterized as having severe depression. For patients diagnosed with MDD, 173 (14.3%) had no antidepressant trials, 578 (47.6%) had one antidepressant trial, 293 (24.1%) had two antidepressant trials, 111 (9.1%) had three antidepressant trials, 38 (3.1%) had four antidepressant trials, and 21 (1.7%) trialed five or more antidepressant medicines. CONCLUSIONS: This initial appraisal of psychiatric outpatients at Akron Children's Hospital diagnosed with major depression suggests rates of treatment-resistant depression similar to rates of adolescent TRD noted in previous landmark studies. While 62% of patients with MDD at Akron Children’s did not exceed one medication trial, about two out of every five patients trialed multiple antidepressant pharmacotherapies. The results of this study evidence the need for alternative or adjunctive interventional therapies to treat treatment-resistant MDD.

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