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S061-1

Clinical and Neurobiological Factors Predict Treatment Resistance in Major
Depressive Disorder

Cheng-Ta Li

Department of Psychiatry, Taipei Veterans General Hospital, Taiwan

Background/Objective: Patients with major depressive disorder (MDD) who fail to respond to
adequate trials of antidepressant treatment is common but may respond to other medication regimens
(e.g., lithium, aripiprazole, quetiapine…etc.). Factors predicting such antidepressant
treatment-resistant depression or medication-resistant depression (MRD) are of clinical importance
and may better management of depression clinically.

Method: In recently years, we conducted several studies to investigate clinical and neurobiological
factors related to the MRD by using the published national data from records of National Health
Insurance claims (1996-2010) in Taiwan and by using MRI and PET neuroimaging scans,
respectively.

We analyzed the published national data from records of National Health Insurance claims. Cases of
MDD during January to December in 2000 (cohort-2000, N=1485) and in 2003 (cohort-2003,
N=2459) were collected from a nationally representative cohort of 1,000,000 enrollees. Patients
responding well to antidepressants were compared to those showing poor-responses to adequate trials
of antidepressants.

Result: Many clinical factors, such as poor-responses to adequate trials of antidepressants, high level
of insomnia or hypnotic uses, and more painful symptoms, are associated with MRD.
Neurobiologically, brain abnormalities in the dorsolateral prefrontal cortex, supplementary motor
areas, and thalamus are associated with MRD.

Conclusion: MRD is common and predictable. Our findings suggest that carefully clinical
judgement, and/or in combination of brain evaluation, enhance the likelihood of treatment responses
in patients presented with major depression.