Depression treatment failure weighs on patients’ lives and wallets


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

Of 10,710 adults with self-reported major depressive disorder (MDD) who participated in the 2019 National Health and Wellbeing Survey, 1,077 reported experiencing treatment failure leading them to try new medications in Due to their non-response, Larry Culpepper, MD, of The Boston University School of Medicine and colleagues reported at Psych Congress 2022.

Of those patients who experienced depression treatment failure, many reported poor quality of life and high medical costs.

However, those with more severe depression tended to carry more of these burdens. For example, in a comparison of scores on three measures of quality of life, people with severe major depressive disorder scored significantly lower than those with milder illness:

  • Short form (SF)-36v2 mental component: 21.8 points for severe MDD versus 42.3 for mild MDD
  • Physical component SF-36v2: 43.9 points for severe TDM against 47.8 for light TDM
  • EuroQol 5-Dimension Visual Analogue score: 45.3 points for severe MDD versus 67.6 for mild MDD

In addition to this, 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 such as emergency room visits, health care provider visits, and hospitalizations — averaging $9,447. These direct medical costs increased to $10,428 for moderate MDD, decreased slightly to $8,673 for moderate to severe MDD, but then rose to $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 work absenteeism – followed a similar trend:

  • $5,131 for moderate to severe MDD

Indirect costs were calculated by taking the number of hours of work missed due to health reasons (representing absenteeism) plus the number of hours worked with reduced productivity due to health issues (representing presenteeism) and multiplying them by the median hourly wages established by the Bureau of Labor Statistics.

“The main finding of this analysis was that among patients who report prior treatment failure, there is a high humanistic burden in terms of poor health-related quality of life as well as high direct and indirect medical costs,” said said Mousam Parikh, MSc, director of health economics outcomes research for psychiatry at AbbVie, who presented the findings, told 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 in patients who have previously failed treatment for MDD, regardless of the severity of the disease,” she added.

Although the researchers weren’t necessarily surprised by the results, given 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-report prior treatment failure.”

“Given that patients with MDD can often go through different treatment options during their disease journey, these results reflect the considerable unmet need felt by these patients,” she pointed out.

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

“Furthermore, the high proportion of patients in this analysis reporting anxiety disorder comorbidity underscores the need for early effective treatment as these patients may have poorer patient outcomes compared to patients without comorbid mental disorders,” said she noted.

Regardless of MDD severity, comorbid anxiety was quite common, affecting:

  • 62.7% of people with mild MDD
  • 77.9% of people with moderate MDD
  • 81.3% of people with moderate to severe MDD
  • 87.6% of people with severe MDD

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

All survey respondents were US residents aged 18 and over. MDD was defined as a self-reported diagnosis of depression by a physician, and people with bipolar I disorder or schizophrenia in the past 12 months were excluded.

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

  • Kristen Monaco is a writer, specializing in endocrinology, psychiatry and nephrology news. Based in the New York office, she has been with the company since 2015.


The study was funded by AbbVie.

Culpepper reported several revelations, including a relationship with AbbVie.


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