Toward an Evidence-Based, Operational Definition of Treatment-Resistant Depression

2017 ◽  
Vol 74 (1) ◽  
pp. 9 ◽  
Author(s):  
Charles R. Conway ◽  
Mark S. George ◽  
Harold A. Sackeim
Keyword(s):  
Operational Definition ◽  
Evidence Based ◽  
Treatment Resistant Depression ◽  
Treatment Resistant ◽  
Resistant Depression ◽  
Definition Of

scholarly journals Pharmacological Augmentation in Unipolar Depression: A Guide to the Guidelines

2020 ◽  
Vol 23 (9) ◽  
pp. 587-625 ◽  
Author(s):  
Rachael W Taylor ◽  
Lindsey Marwood ◽  
Emanuella Oprea ◽  
Valeria DeAngel ◽  
Sarah Mather ◽  
...  
Keyword(s):  
Treatment Guidelines ◽  
Evidence Based ◽  
Treatment Resistant Depression ◽  
Treatment Resistant ◽  
Comprehensive Overview ◽  
Objective Evidence ◽  
Resistant Depression ◽  
Evidence Based Care ◽  
Guidelines For Depression

Abstract Background Pharmacological augmentation is a recommended strategy for patients with treatment-resistant depression. A range of guidelines provide advice on treatment selection, prescription, monitoring and discontinuation, but variation in the content and quality of guidelines may limit the provision of objective, evidence-based care. This is of importance given the side effect burden and poorer long-term outcomes associated with polypharmacy and treatment-resistant depression. This review provides a definitive overview of pharmacological augmentation recommendations by assessing the quality of guidelines for depression and comparing the recommendations made. Methods A systematic literature search identified current treatment guidelines for depression published in English. Guidelines were quality assessed using the Appraisal of Guidelines for Research and Evaluation II tool. Data relating to the prescription of pharmacological augmenters were extracted from those developed with sufficient rigor, and the included recommendations compared. Results Total of 1696 records were identified, 19 guidelines were assessed for quality, and 10 were included. Guidelines differed in their quality, the stage at which augmentation was recommended, the agents included, and the evidence base cited. Lithium and atypical antipsychotics were recommended by all 10, though the specific advice was not consistent. Of the 15 augmenters identified, no others were universally recommended. Conclusions This review provides a comprehensive overview of current pharmacological augmentation recommendations for major depression and will support clinicians in selecting appropriate treatment guidance. Although some variation can be accounted for by date of guideline publication, and limited evidence from clinical trials, there is a clear need for greater consistency across guidelines to ensure patients receive consistent evidence-based care.

scholarly journals A Delphi-method-based consensus guideline for definition of treatment-resistant depression for clinical trials

2021 ◽  
Author(s):  
Luca Sforzini ◽  
Courtney Worrell ◽  
Melisa Kose ◽  
Ian M. Anderson ◽  
Bruno Aouizerate ◽  
...  
Keyword(s):  
Clinical Trials ◽  
Lived Experience ◽  
Delphi Method ◽  
Treatment Resistant Depression ◽  
Treatment Resistant ◽  
Regulatory Bodies ◽  
Resistant Depression ◽  
Operational Criteria ◽  
Definition Of ◽  
International Experts

AbstractCriteria for treatment-resistant depression (TRD) and partially responsive depression (PRD) as subtypes of major depressive disorder (MDD) are not unequivocally defined. In the present document we used a Delphi-method-based consensus approach to define TRD and PRD and to serve as operational criteria for future clinical studies, especially if conducted for regulatory purposes. We reviewed the literature and brought together a group of international experts (including clinicians, academics, researchers, employees of pharmaceutical companies, regulatory bodies representatives, and one person with lived experience) to evaluate the state-of-the-art and main controversies regarding the current classification. We then provided recommendations on how to design clinical trials, and on how to guide research in unmet needs and knowledge gaps. This report will feed into one of the main objectives of the EUropean Patient-cEntric clinicAl tRial pLatforms, Innovative Medicines Initiative (EU-PEARL, IMI) MDD project, to design a protocol for platform trials of new medications for TRD/PRD.

Therapeutic Strategies for Treatment-resistant Depression: State of the Art and Future Perspectives

2020 ◽  
Vol 26 (2) ◽  
pp. 244-252
Author(s):  
Kah K. Goh ◽  
Shen-Chieh Chang ◽  
Chun-Hsin Chen ◽  
Mong-Liang Lu
Keyword(s):  
Antidepressant Treatment ◽  
Repetitive Transcranial Magnetic Stimulation ◽  
Treatment Options ◽  
Therapeutic Strategies ◽  
Evidence Based ◽  
Inadequate Response ◽  
Treatment Resistant Depression ◽  
Treatment Resistant ◽  
Treatment Choices ◽  
Resistant Depression

In this narrative review, we intended to summarize the evidence of pharmacological and somatic treatment choices for treatment-resistant depression (TRD). There are several types of therapeutic strategies to improve inadequate response to antidepressant treatment. The first step for patients with TRD is to optimize the dosage and duration of antidepressants as well as to ensure their drug compliance. The shift to antidepressant and antidepressant combination therapy for patients with TRD cannot be regarded as an evidence-based strategy. Only the combination of a monoamine reuptake inhibitor with a presynaptic α2-autoreceptor antagonist might have better efficacy than other antidepressant combinations. Currently, the most evidence-based treatment options for TRD are augmentation strategies. Among augmentative agents, second-generation antipsychotics and lithium have the strongest evidence for the management of TRD. Further studies are needed to evaluate the augmentative efficacy of anticonvulsants, thyroid hormone, glutamatergic agents, anti-inflammatory agents, and nutraceuticals for TRD. Among somatic therapies, electroconvulsive therapy and repetitive transcranial magnetic stimulation are effective for TRD. Further studies are warranted to provide clinicians with a better recommendation in making treatment choices in patients with TRD.

scholarly journals Electroconvulsive therapy for depression: 80 years of progress

2021 ◽  
pp. 1-4
Author(s):  
George Kirov ◽  
Sameer Jauhar ◽  
Pascal Sienaert ◽  
Charles H. Kellner ◽  
Declan M. McLoughlin
Keyword(s):  
Effective Treatment ◽  
Electroconvulsive Therapy ◽  
Scientific Literature ◽  
Evidence Based ◽  
Efficacy And Safety ◽  
Treatment Resistant Depression ◽  
Treatment Resistant ◽  
Mainstream Media ◽  
Resistant Depression

Electroconvulsive therapy is the most effective treatment for severe, psychotic or treatment-resistant depression. However, its effectiveness continues to be questioned, both in mainstream media and narratives within the scientific literature. In this analysis, we use an evidence-based approach to demonstrate the efficacy and safety of modern electroconvulsive therapy.

Therapy of Treatment Resistant Depression: Focus on the Management of TRD with Atypical Antipsychotics

CNS Spectrums ◽  
2004 ◽  
Vol 9 (11) ◽  
pp. 823-832 ◽  
Author(s):  
Nikolas Klein ◽  
Julia Sacher ◽  
Helene Wallner ◽  
Johannes Tauscher ◽  
Siegfried Kasper
Keyword(s):  
Atypical Antipsychotics ◽  
Symptom Improvement ◽  
Treatment Resistant Depression ◽  
Treatment Resistant ◽  
Major Depressive ◽  
Adequate Treatment ◽  
Resistant Depression ◽  
Operational Criteria ◽  
Definition Of ◽  
Diagnosis Criteria

ABSTRACTTreatment-resistant depression (TRD) represents a significant challenge for physicians. About one third of patients with major depressive disorder fail to experience sufficient symptom improvement despite adequate treatment. Despite this high occurrence of TRD there was no general consensus on diagnosis criteria for TRD until 1997 when researchers proposed a model of defining and staging TRD. In 1999, others defined operational criteria for the definition of TRD. Treatment of TRD is commonly separated into pharmacologic and nonpharmacologic methods. This review gives a short overview of these two methods. The nonpharmacologic methods include psychotherapy, electroconvulsive therapy, and vagus nerve stimulation. Pharmacologic methods include switching to another antidepressant monotherapy, and augmentation or combination with two or more antidepressants or other agents. This review especially focuses on the augmentation of the antidepressant therapy with atypical antipsychotics.

scholarly journals Off-label use of ketamine for treatment-resistant depression in clinical practice: European perspective

2019 ◽  
Vol 215 (2) ◽  
pp. 447-448 ◽  
Author(s):  
Álvaro López-Díaz ◽  
Manuel Murillo-Izquierdo ◽  
Elisa Moreno-Mellado
Keyword(s):  
Clinical Practice ◽  
Public Healthcare ◽  
Evidence Based ◽  
European Perspective ◽  
Treatment Resistant Depression ◽  
Off Label Use ◽  
Treatment Resistant ◽  
Off Label ◽  
Resistant Depression ◽  
Label Use

SummaryKetamine therapy for treatment-resistant depression in European national health systems may only be considered after attempting all evidence-based antidepressant strategies outlined in clinical guidelines. This paper seeks to explain the ethical, regulatory and procedural framework for the off-label use of ketamine for treatment-resistant depression within a public healthcare system.Declaration of interestNone.

scholarly journals Augmentative Pharmacological Strategies in Treatment-Resistant Major Depression: A Comprehensive Review

2021 ◽  
Vol 22 (23) ◽  
pp. 13070
Author(s):  
Alice Caldiroli ◽  
Enrico Capuzzi ◽  
Ilaria Tagliabue ◽  
Martina Capellazzi ◽  
Matteo Marcatili ◽  
...  
Keyword(s):  
Treatment Resistant Depression ◽  
Treatment Resistant ◽  
Short Term ◽  
Negative Results ◽  
Augmentation Strategy ◽  
Resistant Depression ◽  
Poor Outcomes ◽  
Definition Of ◽  
Positive Results ◽  
Intravenous Ketamine

Treatment resistant depression (TRD) is associated with poor outcomes, but a consensus is lacking in the literature regarding which compound represents the best pharmacological augmentation strategy to antidepressants (AD). In the present review, we identify the available literature regarding the pharmacological augmentation to AD in TRD. Research in the main psychiatric databases was performed (PubMed, ISI Web of Knowledge, PsychInfo). Only original articles in English with the main topic being pharmacological augmentation in TRD and presenting a precise definition of TRD were included. Aripiprazole and lithium were the most investigated molecules, and aripiprazole presented the strongest evidence of efficacy. Moreover, olanzapine, quetiapine, cariprazine, risperidone, and ziprasidone showed positive results but to a lesser extent. Brexpiprazole and intranasal esketamine need further study in real-world practice. Intravenous ketamine presented an evincible AD effect in the short-term. The efficacy of adjunctive ADs, antiepileptic drugs, psychostimulants, pramipexole, ropinirole, acetyl-salicylic acid, metyrapone, reserpine, testosterone, T3/T4, naltrexone, SAMe, and zinc cannot be precisely estimated in light of the limited available data. Studies on lamotrigine and pindolol reported negative results. According to our results, aripiprazole and lithium may be considered by clinicians as potential effective augmentative strategies in TRD, although the data regarding lithium are somewhat controversial. Reliable conclusions about the other molecules cannot be drawn. Further controlled comparative studies, standardized in terms of design, doses, and duration of the augmentative treatments, are needed to formulate definitive conclusions.

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