<p>Definition and Identification of Patients with Treatment-Resistant Depression in Real-World Clinical Practice Settings Across Asia</p>

Abstract

Purpose: An Asia-Pacific expert consensus defined treatment-resistant depression (TRD) as failure of ≥2 antidepressants given at adequate doses for 6-8 weeks during a major depressive episode. A survey examined how TRD was being diagnosed in real-world practices across Asia. An expert panel then interpreted the results and provided practical recommendations. Methods: Between March and July 2018, 246 clinicians from Hong Kong, Japan, Mainland China, South Korea, and Taiwan were surveyed on how they identified TRD patients according to their own definitions. Results: Most physicians described antidepressant failure as "no response" (79%) or "inadequate response" (82%); fewer chose "failure to achieve remission" (45%). About 40% did not routinely use clinical tools to assess response. Around 52% defined adequate dose target as achieving the label's upper dose limit. About 58% would treat for 4-8 weeks before determining antidepressant failure. Most (76%) required the ≥2 qualifying antidepressant failures to be from different classes. Approximately 60% considered antidepressant failure(s) from previous depressive episode(s) when diagnosing TRD. Conclusion: Considering the survey results, antidepressant failure can be defined as a failure to achieve remission, or more practically as <50% improvement in depressive symptoms or inability to return to work/study, and confirmed with a clinical tool. TRD diagnosis also requires ≥2 qualifying antidepressant failures within the same depressive episode; from the same or different classes; and achieving at least the minimum effective antidepressant dose for 6-8 weeks.

Associations of Suicide Risk and Community Integration Among Patients With Treatment-Resistant Depression

“…Despite the varied definitions across the world, TRD has been defined and recognized as not responding to two adequate antidepressant medication regimens for patients with MDD ( 4 ). Further, two review and consensus studies of the Asian populations defined TRD as failure of at least two antidepressant trials at an adequate dose for 6–8 weeks during any MDD episode ( 5 , 6 ). The management of disease and follow-up care among patients with TRD is put forward as an important issue.…”

Peripheral prognostic biomarkers of response in treatment-resistant depression

“…[19][20][21][22] Παρομοίως, στις περισσότερες real-world μελέτες, οι ασθενείς θεωρήθηκαν ανθεκτικοί στη θεραπεία όταν δεν ανταποκρίνονταν επαρκώς σε τουλάχιστον δύο τύπους αντικαταθλιπτικών, γεγονός που συνάδει με τον πιο ευρέως χρησιμοποιούμενο ορισμό της TRD στην κλινική έρευνα. 23 Άλλες μελέτες όμως, χρησιμοποίησαν και διαφορετικά κριτήρια, όπως η ανθεκτικότητα σε τουλάχιστον τρία ψυχοτρόπα φάρμακα, η ανεπαρκής ανταπόκριση στη θεραπεία με κεταμίνη, αλλά και ορισμούς βασισμένους σε διάφορα βαθμολογικά κριτήρια ψυχομετρικών εργαλείων.…”

Modulation of resting-state functional connectivity in default mode network is associated with the long-term treatment outcome in major depressive disorder

“…However, the treatment response to antidepressants varies between individuals (Trivedi et al, 2006). Studies have demonstrated that approximately one-third of the patients with MDD were unable to achieve full remission even after being administered two or more antidepressants at adequate doses for more than 8 weeks of continued therapy (Angstman, Pietruszewski, Rasmussen, Wilkinson, & Katzelnick, 2012; Han et al, 2020; Sinyor, Schaffer, & Levitt, 2010). In addition, at least one-third of the patients developed a recurrent episode after recovery from the previous depressive episode (Kanai et al, 2003; Moffitt et al, 2010).…”