engleski

The lack of association between components of metabolic syndrome and treatment resistance in depression

Although a number of studies investigated the link between major depressive disorder (MDD) and metabolic syndrome (MetS), the association between MetS and treatment-resistant depression (TRD) is still not clear. The aim of the study was to investigate the relationship between TRD and MetS and/or components of MetS and cardiovascular risk factors. Given the high prevalence of both conditions, the hypothesis was that TRD would be significantly associated with MetS. This cross-sectional study included 203 inpatients with MDD, assessed for the treatment resistance, MetS and its components, and severity of MDD. Diagnoses and evaluations were made with SCID based on DSM-IV, National Cholesterol Education Program Adult Treatment Panel III criteria, and the Hamilton Depression Rating Scale. The results of the present study showed that MetS occurred similarly in patientswith orwithout TRD, and that distribution of patients with the presence of particular components of the MetS (elevated glucose, elevated TG, low HDL, elevated blood pressure, and increased waist circumference), or alteration in other variables of cardiovascular risk (BMI, LDL, cholesterol, atherogenic index 1 and 2) did not differ significantly between patients with and without TRD. Marginally increased glucose levels were found more frequently in patients with TRD compared to non-TRD patients, but the significance was lost after Bonferroni correction. In general, our sample was characterized by patients with relatively late age of onset of MDD (both TRD and non-TRD patients experienced their first episode after the age of 40 years). Given that patients with TRD were older, vascular etiology could also have contributed to MDD onset and the development of treatment resistance. However, the results of the present study show no differences between patients with and without TRD in the frequency of components of MetS, BMI, and both atherogenic index 1 and 2. These findings strongly argue against the differences in vascular pathology between patients with and without TRD. Limitations of the study are cross-sectional design and the fact that patients were treated with different antidepressants. This study had adequate power (≥0.800) to detect significant differences in age, number of depressive episodes, duration of illness, and number of previous suicide attempts between patients with or without TRD. Therefore, further research is needed on a larger number of patients with TRD. The results of the study did not confirm the hypothesis that MetS, its components, or variables of cardiovascular risk factors, would be found more frequently in patients with TRD compared to non-TRD patients. Although methodological and sample size limitations do not allow definitive conclusions, and given the long-term health consequences of both MetS and TRD, the relationship between componentsof MetS and TRD deserves further investigation in adequately powered studies.

major depressive disorder; metabolic syndrome; components of metabolic syndrome; tretmant resistance

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