Background: Little data exist to inform the treatment of severe and resistant affective disorders. We report here the effectiveness of specialist multimodal inpatient treatment for refractory affective disorders.
Methods: Prospective evaluation of 225 consecutive patients admitted to the National Affective Disorders Unit between 2001 and 2008.
Results: Patients were highly treatment-resistant: most had already received ECT, lithium augmentation and over 10 prior treatment trials. Even so, sequential assessment with the Hamilton Depression Rating Scale found that 69% showed a clinical response (≥ 50% reduction in Hamilton score) to intensive therapy during admission; 50% continued to sustain a full response and 71% at least a partial response on discharge. Patients' self-ratings (57% very much or much improved, 24% slightly improved) and relative and referrer reports (75% and 68% respectively rated patients as improved) gave similar levels of improvement.
Limitations: This was an observational study, without any untreated control group. The generalisability of the findings is limited by the highly specialised nature of the unit.
Conclusions: Most patients with depression highly resistant to prior treatment respond to specialist and intensive multimodal inpatient therapy.
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