scholarly journals Definition of treatment-resistant depression – Asia Pacific perspectives

2019 ◽  
Vol 245 ◽  
pp. 626-636 ◽  
Author(s):  
C.H. Ng ◽  
T. Kato ◽  
C. Han ◽  
G. Wang ◽  
M. Trivedi ◽  
...  
Keyword(s):  
Asia Pacific ◽  
Treatment Resistant Depression ◽  
Treatment Resistant ◽  
Resistant Depression ◽  
Definition Of

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.

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 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.

scholarly journals Current perspectives in the management of treatment-resistant depression

2004 ◽  
Vol 6 (1) ◽  
pp. 53-60
Keyword(s):  
Depressive Disorders ◽  
Antidepressant Treatment ◽  
Behavioral Therapy ◽  
Treatment Resistance ◽  
Care Utilization ◽  
Treatment Resistant Depression ◽  
Treatment Resistant ◽  
Combination Strategies ◽  
Resistant Depression ◽  
Definition Of

Depressive disorders are a leading cause of disability worldwide and greatly impact morbidity, health care utilization, and medical costs. Major depression that does not resolve with adequate antidepressant treatment is termed treatment-resistant depression (TRD), There is no universally accepted definition of TRD and several criteria have been suggested to define it. Multiple factors can contribute to treatment resistance, including unrecognized comorbid medical or psychiatric illness, the use of concomitant medications, noncompliance, and psychosocial stressors. TRD is associated with extensive use of depression-related and general medical services, and poses a substantial economic burden. Current approaches to its management include the use of antidepressant strategies, such as increasing the dose of the antidepressant, augmentation strategies, combination strategies, and switching strategies, electroconvulsive therapy, and cognitive behavioral therapy. Although no definite algorithm exists for treating TRD, research in this area has advanced considerably in recent years. One approach to this is a clinical trial called STAR*D (Sequenced Treatment Alternatives to Relieve Depression). This has the potential to increase our understanding about the diagnostic and therapeutic aspects of TRD, to substantially reduce disability, and to enhance the quality of life in individuals with this condition.

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