CHARACTERISTICS OF DESIPRAMINE-REFRACTORY DEPRESSION

Background: To determine the predictors of desipramine-refractory depr ession, the authors examined the outcome in patients with major depres sion who were admitted to a general hospital and treated with desipram ine adjusted to an adequate blood level. Method: Sixty-eight consecuti ve inpatients with DSM-III nonpsychotic unipolar major depression who had failed to respond to 1 week of hospitalization without drug treatm ent were studied. Outcome was assessed with the Yale Depression Invent ory after a 4-week desipramine trial in which 24-hour plasma concentra tions were used to rapidly achieve a therapeutic desipramine level. Re sults: Poor response to a therapeutic desipramine trial, which occurre d in 15 of 50 patients, was significantly associated with definite per sonality disorder, prior treatment failure, near delusional status, ag e less than or equal to 35 years, duration of depressive episode, recu rrence of depression, dysthymia, and secondary depression. The first f our items remained significantly correlated with poor response when th e presence of the other items was accounted for using multiple regress ion. Drug response was not predicted by the diagnosis of melancholia ( DSM-III and DSM-III-R) or initial severity of the depressive episode. Conclusion: The four strongest correlates of outcome were highly predi ctive of drug response. In patients with two or more predictors, only 25% (4 of 16) responded, while in those with or no predictors, 91% (31 of 34) responded.