1. Definition of treatment-resistant depression - Asia Pacific perspectives.
- Author
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Ng, C.H., Kato, T., Han, C., Wang, G., Trivedi, M., Ramesh, V., Shao, D., Gala, S., Narayanan, S., Tan, W., Feng, Y., and Kasper, S.
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PANEL analysis , *QUALITY of life , *CLINICAL trials , *META-analysis , *ANTIDEPRESSANTS , *DIAGNOSIS of mental depression , *CONSENSUS (Social sciences) , *MENTAL depression , *PSYCHOTHERAPY , *TREATMENT effectiveness - Abstract
Background: The lack of uniformity in the definition of treatment resistant depression (TRD) within the Asia-Pacific (APAC) region may have implications for patient management. We aimed to characterize the most commonly used TRD definition in selected APAC countries.Methods: A systematic literature review of TRD definitions in APAC countries was conducted in Medline and Embase (2010-2016) and conference proceedings (2014 and 2016). TRD guidelines (APAC, Europe regional, US, or international) were also searched. An expert-panel explored APAC nuances in TRD definitions to achieve consensus for a regional-level definition.Results: Ten guidelines and 89 studies qualified for study inclusion. Among the studies, variations were observed in definitions regarding: number of antidepressants failed (range: ≥1 to ≥3), classes of antidepressants (same or different; 59% did not specify class), duration of previous treatments (range: 4-12 weeks), dosage adequacy, and consideration of adherence (yes/no; 88% of studies did not consider adherence). No TRD-specific guidelines were identified. The emerging consensus from the literature review and panel discussion was that TRD is most commonly defined as failure to ≥2 antidepressant therapies given at adequate doses, for 6-8 weeks during a major depressive episode.Limitations: Few studies provided definitions of TRD used in daily clinical practice, and a limited number of countries were represented in the included studies and expert panel.Conclusion: Attaining consensus on TRD definition may promote accurate, and possibly early detection of patients with TRD to enable appropriate intervention that may impact patient outcomes and quality of life. [ABSTRACT FROM AUTHOR]- Published
- 2019
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