The impact of comorbid post-traumatic stress disorder in patients with major depressive disorder on clinical features, pharmacological treatment strategies, and treatment outcomes – Results from a cross-sectional European multicenter study

Markus Dold, Lucie Bartova, Alexander Kautzky, Daniel Souery, Julien Mendlewicz, Alessandro Serretti, Stefano Porcelli, Joseph Zohar, Stuart Montgomery, Siegfried Kasper*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

Abstract

This international, multicenter, cross-sectional study comprising 1346 adult in- and outpatients with major depressive disorder (MDD) investigated the association between MDD as primary diagnosis and comorbid post-traumatic stress disorder (PTSD). In a cross-sectional data collection process, the presence of comorbid PTSD was determined by the Mini International Neuropsychiatric Interview (MINI) and the patients’ socio-demographic, clinical, psychopharmacological, and response information were obtained. Clinical features between MDD with and without concurrent PTSD were compared using descriptive statistics, analyses of covariance (ANCOVA), and binary logistic regression analyses. 1.49% of the MDD patients suffered from comorbid PTSD. Significantly more MDD + comorbid PTSD patients exhibited atypical features, comorbid anxiety disorders (any comorbid anxiety disorder, panic disorder, agoraphobia, and social phobia), comorbid bulimia nervosa, current suicide risk, and augmentation treatment with low-dose antipsychotic drugs. In the binary logistic regression analyses, the presence of atypical features (odds ratio (OR) = 4.49, 95%CI:1.01–20.12; p≤.05), any comorbid anxiety disorder (OR = 3.89, 95%CI:1.60-9.44; p = .003), comorbid panic disorder (OR = 6.45, 95%CI:2.52–16.51; p = .001), comorbid agoraphobia (OR = 6.51, 95%CI:2.54-16.68; p≤.001), comorbid social phobia (OR = 6.16, 95%CI:1.71–22.17; p≤.001), comorbid bulimia nervosa (OR = 10.39, 95%CI:1.21–88.64; p = .03), current suicide risk (OR = 3.58, 95%CI:1.30–9.91; p = .01), and augmentation with low-potency antipsychotics (OR = 6.66, 95%CI:2.50–17.77; p<.001) were associated with concurrent PTSD in predominant MDD. Major findings of this study were (1.) the much lower prevalence rate of comorbid PTSD in predominant MDD compared to the reverse prevalence rates of concurrent MDD in primary PTSD, (2.) the high association to comorbid anxiety disorders, and (3.) the increased suicide risk due to concurrent PTSD.

Original languageEnglish
Pages (from-to)625-632
Number of pages8
JournalEuropean Neuropsychopharmacology
Volume27
Issue number7
DOIs
StatePublished - Jul 2017
Externally publishedYes

Keywords

  • Antidepressants
  • Antipsychotics
  • Comorbidities
  • Major depressive disorder
  • Post-traumatic stress disorder
  • Treatment response

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