Prospective evaluation of specialist inpatient treatment for refractory affective disorders

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. (C) 2010 Elsevier B.V. All rights reserved.