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Reason for treatment resistance

Posted by scatterbrained on March 8, 2006, at 0:39:59

The following is an article I found that might give explaination as to why some of us are treatment resistent

"Brain white-matter hyperintensities linked to antidepressant outcome

Subcortical white-matter hyperintensities in the left hemisphere, but not in other brain areas, may be associated with poor response to antidepressant medication in people with major depression, investigators have found.

Moreover, the findings suggest that a large proportion of brain hyperintensities might be vascular in origin.

"The association between major depressive disorder and increased prevalence of brain white-matter hyperintensities has been reported in elderly people, but studies in younger patients have been inconclusive," Dan Iosifescu (Massachusetts General Hospital, Boston, USA) and colleagues observe.

To address this, the team assessed brain white-matter hyperintensities and cardiovascular risk factors in 84 people, aged an average of 39.6 years, with major depressive disorder prior to initiating antidepressant treatment.

For comparison, hyperintensities in 35 mentally healthy individuals were also assessed.

Although the researchers were unable to find any correlation between global white-matter hyperintensity measures and clinical outcome, subcortical hyperintensities were evident in the left hemispheres of depressed patients who had a poor response to antidepressant treatment.

After adjusting for age, subcortical white-matter hyperintensities in the left hemisphere correlated with lower rates of response, with an odds ratio of 10.1. In contrast, the correlation between hyperintensities in this part of the brain and remission did not reach statistical significance.

White-matter hyperintensities were also correlated with hypertension and total scores for six cardiovascular risk factors - increasing age, hypertension, family history of cardiovascular disease, smoking, diabetes, and hypercholesterolemia.

"One personal interpretation of our results is that cardiovascular risk factors correlate with a higher severity of subcortical white-matter lesions, which in turn correlates with poor treatment outcome in depression," write Iosifescu et al in the British Journal of Psychiatry.

This interpretation is consistent with the "vascular depression" model, they note, although global measures of white-matter hyperintensities would have been expected.

The researchers therefore suggest that specific white-matter tracts may be involved in mood regulation, potentially explaining a selective impact of left-hemisphere subcortical hyperintensities on treatment outcome"

Maybe it's time for some of us to look into WHY we are treatment resistent.




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