Treatment-Resistant Depression: Managed Care Considerations

Lithium or an atypical antipsychotic drug in the management of treatment-resistant depression: a systematic review and economic evaluation

“…However, there is much uncertainty regarding what constitutes the definition of TRD and whether or not, for example, a patient with a failure to respond to two antidepressants from the same class could be defined as treatment resistant. 1,2 For the purposes of this report, TRD has been defined as a failure to respond to two or more antidepressants in the current episode of depression, the definition used in the 2003 National Institute for Health and Care Excellence (NICE) clinical guideline on the treatment and management of depression in adults (CG23). 3 This definition for TRD was also reported by the authors of a large systematic review of 42 randomised trials to reflect the consensus within the literature (26 trials) 4 and in the World Federation of Societies of Biological Psychiatry (WFSBP) guidelines 5 for biological treatment of unipolar depressive disorders.…”

“…2 The highest rates of depression typically occur in people between 25 and 44 years old, and females are twice as likely as males to experience depression, 2 although how these figures relate to the subgroup of patients with TRD is difficult to know owing to the lack of epidemiological data and the lack of a consistent definition for TRD. Family history of depression is also a risk factor for depression 2 and a previous history of MDD increases the risk of future episodes (i.e. relapses).…”

“…6 In addition, it has been reported that patients with depression have increased morbidity and mortality. 2 For example, they are more likely to die from cardiovascular disease 7 or suicide. 8 …”

“…This assumption is supported by reports that patients with TRD use a disproportionately larger share of health-care resources and cost employers more in lost productivity than patients with MDD who respond to treatment. 2,21 A more recent economic review was conducted by the King's Fund in 2006 to estimate expenditure on mental health, including depression, in England up to 2026. 22 This study 22 estimated the total costs for depression, including prescribed drugs, inpatient care, other NHS services, supported accommodation, social services and lost employment.…”

“…2 The aim of this report is to identify how effective adding either lithium or an atypical antipsychotic medication to an antidepressant is at managing people with treatment resistant unipolar depression.…”