Treatment‐resistant depression: resistant to definition?

Malhi, Gin S; Parker, Gordon; Crawford, James; Wilhelm, Kay; Mitchell, Philip B.

doi:10.1111/j.1600-0447.2005.00602.x

Cited by 84 publications

(55 citation statements)

References 26 publications

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“…There is variety among research groups as to whether TRD is a specific subtype of depression or whether it is a nebulous residual category. 19 However, there is an emerging consensus that TRD is usually best understood not as an all-or-none phenomenon but as one that occurs along a continuum ranging from partial response to complete treatment resistance. 2,10,11 Relative Compared With Absolute Resistance.…”

Section: Related Issuesmentioning

confidence: 99%

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Definition, Assessment, and Staging of Treatment—Resistant Refractory Major Depression: A Review of Current Concepts and Methods

2007

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Up to 15% of depression patients eventually present with treatment-resistant or refractory depression (TRD), a condition that causes significant social and economic burdens. Our paper aims to summarize the current medical literature on the conceptual and methodologic issues involved in the definition, assessment, and staging of TRD. Method: We reviewed the recently published medical literature to identify papers that specifically discuss TRD. For this, we searched MEDLINE, EMBASE, and PsycINFO for potentially relevant English-language articles published between January 1996 and June 2006. Results: Recent methodologic and conceptual advances have contributed to the achievement of an acceptable level of theoretical consensus on the general meaning of TRD. Accordingly, depression is usually considered resistant or refractory when at least 2 trials with antidepressants from different pharmacologic classes (adequate in terms of dosage, duration, and compliance) fail to produce a significant clinical improvement. Regarding diagnostic assessments, an accurate and systematic evaluation should be made to elicit the potential role of several contributing factors, such as medical and psychiatric comorbidity. Conclusion: Recently, 3 staging methods for TRD have been described, but they currently require extensive empirical support. Future research on TRD should include prospective studies addressing the validity of the proposed criteria, the impact of depression comorbid with other psychiatric disorders and (or) physical conditions, and the possible predictors of treatment outcome. There is an important and clear need for studies that empirically test current definitions, assessment strategies, and staging methods of TRD.

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Section: Related Issuesmentioning

confidence: 99%

“…In total, we retrieved 327 full electronic references, 16 of which met our selection criteria. [5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20] …”

Section: Literature Search and Reviewmentioning

confidence: 99%

Definition, Assessment, and Staging of Treatment—Resistant Refractory Major Depression: A Review of Current Concepts and Methods

2007

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“…In previous studies we have investigated 'paradigm failures' contributing to TRD (Parker, Malhi, Crawford, & Thase, 2005a) and have identifi ed an overrepresentation of patients with melancholia in a TRD sample (Malhi, Parker, Crawford, Wilhelm, & Mitchell, 2005). Subsequently, we have sought to examine other subgroups and their determinants.…”

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confidence: 99%

Social inhibition and treatment‐resistant depression

Crawford

Parker

Malhi

et al. 2007

Personality & Mental Health

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“…According to research practice, a lack of response (not necessarily TRD per se) is usually defined by "failure to reduce of at least 50% in the Hamilton depression (HAM-D) [17] total score" or as "failure in reducing below a specific cut-off" while less objective TRD clinical definitions include "failure in symptoms resolution" or the more accepted "failure to respond to 2 or more adequate antidepressant trials" [18].…”

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confidence: 99%

Current Nosology of Treatment Resistant Depression: A Controversy Resistant to Revision

Fornaro¹,

Giosue²

2010

CPEMH

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Treatment-Resistant Depression (TRD) represents a source of ongoing clinical and nosological controversy and confusion. While no univocal consensus on its definition and specific correlation with major mood disorders has been reached to date, a progressively greater number of evidences tend to suggest a revision of current clinical nosology. Since a better assessment of TRD should be considered mandatory in order to achieve the most appropriate clinical management, this narrative review aims to briefly present current most accepted definitions of the phenomenon, speculating on its putative bipolar diathesis for some of the cases originally assessed as unipolar depression.Keywords: Treatment Resistant Depression, Bipolar Disorder, Controversy. EPIDEMIOLOGY OF TRD Treatment-resistant depression (TRD) is a relatively common condition presenting with substantial challenges to both the clinician and researcher [1].In fact, despite a progressively higher number of available antidepressant therapies, TRD occurs frequently in clinical practice, and is associated with profound psychosocial disability, personal suffering and economic cost burden. Between one and two thirds of Major Depressive Disorder (MDD) patients will not respond to the first antidepressant prescribed and 15 to 33 percent will "resist" to multiple interventions, including non-pharmacological therapies [2].Increasing the burden associated with MDD, its high prevalence: World Health Organization (WHO) estimated that 5-10% of the population at any given time is suffering from identifiable depression needing psychiatric or psychosocial intervention, while the life-time risk of developing depression is 10-20% in females and slightly less in males [3]. [11] reported that approximately 22% of patients who received treatment for depression by their primary-care physicians remitted following 6 months of treatment, 32% were partial responders, while 45% were non-responders. Similarly, Rush and colleagues [8] reported an 11% remission rate and 26.3% response rate among depressed outpatients following 12 months of treatment of depression in one of several public-sector community clinics. Petersen and colleagues [6] report a 50.4% remission rate among outpatients with MDD enrolled in 1 of 2 hospital-based, academically affiliated depression specialty clinics (Massachusetts General Hospital, an affiliate of Harvard Medical School and Rhode Island Hospital, an affiliate of Brown University) following an average of 25.8 weeks of treatment. Finally, it is also worth noting that while partial or non-response are common, residual symptoms among remitters are also highly prevalent [12,13], being usually associated with poorer psychosocial functioning [14] as well as an increased relapse rates [15], higher suicidal ideation and attempts, higher number of lifetime hospitalizations, more frequent healthcare resources utilization, general practitioner consultation, job loss and social retirement [16]. ISSUES IN DEFINING TRD: A CLINICAL CONTRO-VERSY "RESISTANT TO RE...

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Treatment‐resistant depression: resistant to definition?

Abstract: Melancholia perhaps provides a prototypic TRD subset that perhaps reflects some innate aspects of melancholic depression or factors such as the impact of ageing. Research into TRD is needed to both replicate this finding and perhaps explicate it further.

Cited by 84 publications

References 26 publications

Definition, Assessment, and Staging of Treatment—Resistant Refractory Major Depression: A Review of Current Concepts and Methods

Definition, Assessment, and Staging of Treatment—Resistant Refractory Major Depression: A Review of Current Concepts and Methods

Social inhibition and treatment‐resistant depression

Current Nosology of Treatment Resistant Depression: A Controversy Resistant to Revision

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