A Southeast Asia Consensus on the Definition and Management of Treatment-Resistant Depression

A Southeast Asia Consensus on the Definition and Management of Treatment-Resistant Depression

Introduction: Despite the abundance of literature on treatment-resistant depression (TRD), there is no universally accepted definition of TRD and available treatment pathways for the management of TRD vary across the Southeast Asia (SEA) region, highlighting the need for a uniform definition and tre...

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Published in:Neuropsychiatric disease and treatment Vol. 18; pp. 2747 - 2757
Main Authors: Tor, Phern Chern, Amir, Nurmiati, Fam, Johnson, Ho, Roger, Ittasakul, Pichai, Maramis, Margarita M, Ponio, Benita, Purnama, Dharmawan Ardi, Rattanasumawong, Wanida, Rondain, Elizabeth, Sulaiman, Ahmad Hatim Bin, Wiroteurairuang, Kannokarn, Chee, Kok Yoon
Format: Journal Article
Language:English
Published: Auckland Dove Medical Press Limited 01-01-2022
Taylor & Francis Ltd
Dove
Dove Medical Press
Subjects:
Adults
anti-depressive agents
Care and treatment
Clinical medicine
Consensus (Social sciences)
depression
Depression, Mental
depressive disorder – treatment resistant
Drug dosages
Drug therapy
Electroconvulsive therapy
Emotional disorders
Expert Opinion
FDA approval
Literature reviews
Magnetic fields
major depressive disorder
Management
Mental depression
Mood disorders
Patients
pharmacotherapy
Practice guidelines (Medicine)
Psychiatrists
Psychotherapy
Suicides & suicide attempts
Transcranial magnetic stimulation
Southeast Asia
Asia
Singapore
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Summary:Introduction: Despite the abundance of literature on treatment-resistant depression (TRD), there is no universally accepted definition of TRD and available treatment pathways for the management of TRD vary across the Southeast Asia (SEA) region, highlighting the need for a uniform definition and treatment principles to optimize the management TRD in SEA. Methods: Following a thematic literature review and pre-meeting survey, a SEA expert panel comprising 13 psychiatrists with clinical experience in managing patients with TRD convened and utilized the RAND/UCLA Appropriateness Method to develop consensus-based recommendations on the appropriate definition of TRD and principles for its management. Results: The expert panel agreed that "pharmacotherapy-resistant depression" (PRD) is a more suitable term for TRD and defined it as "failure of two drug treatments of adequate doses, for 4-8 weeks duration with adequate adherence, during a major depressive episode". A stepwise treatment approach should be employed for the management of PRD--treatment strategies can include maximizing dose, switching to a different class, and augmenting or combining treatments. Non-pharmacological treatments, such as electroconvulsive therapy and repetitive transcranial magnetic stimulation, are also appropriate options for patients with PRD. Conclusion: These consensus recommendations on the operational definition of PRD and treatment principles for its management can be adapted to local contexts in the SEA countries but should not replace clinical judgement. Individual circumstances and benefit-risk balance should be carefully considered while determining the most appropriate treatment option for patients with PRD. Keywords: depression, pharmacotherapy, major depressive disorder, anti-depressive agents, depressive disorder--treatment resistant
Bibliography:ObjectType-Article-1
SourceType-Scholarly Journals-1
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ISSN:1178-2021
1176-6328
1178-2021
DOI:10.2147/NDT.S380792