Prospective evaluation of specialist inpatient treatment for refractory affective disorders

BackgroundLittle 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.MethodsProspective evaluation of 225 consecutive patients admitted to the National Affective Disorders Unit between 2001 and 2008.ResultsPatients 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.LimitationsThis was an observational study, without any untreated control group. The generalisability of the findings is limited by the highly specialised nature of the unit.ConclusionsMost patients with depression highly resistant to prior treatment respond to specialist and intensive multimodal inpatient therapy.