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

• 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
• ISSN: 1178-2021; 1176-6328; 1178-2021
• DOI: 10.2147/NDT.S380792

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