Low hedonic tone and attention-deficit hyperactivity disorder: risk factors for treatment resistance in depressed adults

Figures & data

Table 1 Demographic data of patients with and without TRD

Characteristics	TRD (n=97)	Non-TRD (n=63)	χ^2 or T	P-valuea
Age at participation, M (SD)	39.3 (14.3)	34.9 (11.7)	2.12	0.036
Range	18–71	17–60
Gender, n (%)			0.795	0.373
Male	50 (51.5)	37 (58.7)
Female	47 (48.5)	26 (41.2)
Marital status, n (%)			5.70	0.337
Single	57 (58.8)	36 (57.2)
Married	24 (24.7)	12 (19.0)
Cohabiting	9 (9.3)	4 (6.3)
Separated/divorced/widowed	3 (3.1)	3 (4.8)
No response	4 (4.1)	8 (12.7)
Highest level of education, n (%)	(n=63)	(n=46)	2.97	0.226
High school or less	12 (19.0)	14 (30.4)
College/university	36 (57.1)	19 (41.3)
Graduate school	15 (23.8)	13 (28.3)
Personal income level, n (%)	(n=59)	(n=46)	7.40	0.192
<$25,000	27 (45.8)	14 (30.4)
$25,000–$49,999	7 (11.9)	8 (17.4)
$50,000–$74,999	4 (6.8)	7 (15.2)
$75,000–$99,999	5 (8.5)	3 (6.5)
≥$100,000	11 (18.6)	5 (10.9)
Do not know	5 (8.5)	9 (19.6)

Note:

a Comparisons evaluated using the two-sample t-test for the age of participant and the chi-squared test for all other variables.

Abbreviations: M, mean; TRD, treatment-resistant depression.

Table 2 Psychiatric history of patients with and without TRD

	TRD (n=97)	Non-TRD (n=63)	χ^2 or T	P-valuea
Number of psychiatric diagnosis, M (SD)	4.16 (1.51)	2.47 (2.02)	5.54	<0.001
Number of past medications, M (SD)	2.88 (1.56)	1.76 (2.23)	3.72	<0.001
Past SSRI failure, n (%)			1.26	0.262
Yes	42 (43.3)	21 (33.3)
No	55 (56.7)	39 (61.9)
Number of past SSRIs, M (SD)	0.85 (1.13)	0.82 (1.42)	0.155	0.877
Suicide score assessment based on the MINI, M (SD)	4.32 (7.67)	4.08 (6.20)	0.201	0.491
Suicide ideation assessment based on the MINI, n (%)	60 (65.2)	32 (51.6)	7.01	0.008
Suicide attempt assessment based on the MINI, n (%)	16 (17.4)	15 (24.2)	1.07	0.302
Anhedonia assessment based on the MINI, n (%)
Past episode	84 (91.3)	42 (67.7)	13.8	<0.001
Present episode	54 (58.7)	23 (37.1)	6.91	0.009
Chronic (LHT)	53 (57.6)	23 (37.1)	6.24	0.013
Psychiatric comorbidities,b n (%)
Generalized anxiety disorder	79 (81.4)	44 (69.8)	2.89	0.089
Social phobia	52 (53.6)	36 (57.1)	0.193	0.661
Agoraphobia	31 (32.0)	26 (41.3)	1.44	0.230
Panic disorder	31 (32.0)	25 (39.7)	1.00	0.317
Bipolar	0 (0)	29 (46.0)	54.5	<0.001
OCD	21 (21.6)	22 (34.9)	3.42	0.064
PTSD	15 (15.5)	3 (4.8)	1.75	0.186
Alcohol dependence and abuse	8 (11.3)	10 (15.9)	2.22	0.136
Substance dependence and abuse	11 (8.2)	7 (11.1)	0.067	0.795
Bulimia nervosa	2 (2.1)	5 (7.9)	3.15	0.076
Anorexia nervosa	1 (1)	1 (1.6)	0.096	0.757
Psychotic disorders	0	4 (6.3)	6.32	0.012
Specific phobia	10 (10.3)	6 (9.5)	0.026	0.871
ADHD	33 (34)	26 (41.2)	8.07	0.005

Notes:

a Comparisons were evaluated using the two-sample t-test for the number of diagnoses, past medications, past SSRI failures, and the Chi-squared test for all other variables.

b Psychiatric diagnoses were assessed using the MINI at the time of intake interview and confirmed by treating psychiatrist. The number of past medications, past SSRIs, and number of past SSRIs were assessed during the intake interview in combination with referral documentation.

Abbreviations: ADHD, attention-deficit hyperactivity disorder; LHT, low hedonic tone; M, mean; MINI Plus, Mini International Neuropsychiatric Interview Plus; OCD, obsessive and compulsive disorder; PTSD, posttraumatic stress disorder; SSRI, selective serotonin reuptake inhibitor; TRD, treatment-resistant depression.

Figure 1 Comparison of anhedonic features between the TRD-alone and TRD/ADHD groups.

Note: A comparison of anhedonic features between the TRD-alone (n=59) and TRD with comorbid ADHD (n=33) groups.
Abbreviations: ADHD, attention-deficit hyperactivity disorder; TRD, treatment-resistant depression.