Longer Duration of untreated MDD linked to severe clinical symptoms of depression, anxiety, and suicide attempts

China: A new study found that a longer duration of untreated major depressive disorders can lead to severe clinical symptoms of depression, anxiety, and suicide attempts. The study results were published in the journal Psychiatry Research. 

Duration of untreated illness (DUI) is the time interval between the first presentation of depressive symptoms and the first adequate medication. Recently DUI has been extensively researched and it has shown that a prolonged DUI leads to poorer outcomes. This has led to extensive changes in mental health services globally. As the treatment outcomes for major depressive disorder (MDD) are worse and there is a high necessity to improve the treatment outcomes of MDD, it is important to identify the factors that influence prognosis and investigate ways to cope with them. Since most studies on DUI have focused on schizophrenia and other related psychosis researchers from China, aimed to assess the possible relationship between DUI and certain clinical correlates in the first episode and drug-naïve patients with major depressive disorder (MDD). 

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A cross-sectional study was carried out by recruiting 1,718 first-episode and drug naïve MDD outpatients. Along with the measurement of the thyroid hormone and metabolic parameters, all participants were scored on the Hamilton Depression Rating Scale, Hamilton Anxiety Rating Scale, and Positive and Negative Syndrome Scale. Structured Clinical Interview for DSM-IV was used for clinical diagnosis and investigated suicide attempts were identified through face-to-face interviews. 

Key findings of the study: 

• Co-morbid psychiatric symptoms were found in nearly 171 (10%) of the total MDD patients.
• When compared to their counterparts, older participants, with lower education levels, and married were less likely to seek timely treatment. 
• One-month longer untreated duration was associated with 2% to 9% higher odds of being with most of the investigated clinical conditions.
• The longest DUI was associated with an increased risk for most of the investigated clinical conditions, with absolute risk differences ranging from 5.19% to 29.48%.  

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Thus, this study is the first of its kind to examine the relationship between DUI and clinical correlates in first-episode drug-naïve MDD patients. The study confirmed that longer DUI was associated with more severe clinical features, including severe depressive symptoms, anxiety symptoms, attempted suicide, and abnormal levels of thyroid hormones and lipid profile. 

Further reading: Luo G, Li Y, Yao C, Li M, Li J, Zhang X. Duration of untreated illness and clinical correlates in first-episode and drug-naïve patients with major depressive disorder. Psychiatry Research. Published online January 2023:115056. doi: 10.1016/j.psychres.2023.115056