Definition and Identification of Patients with Treatment-Resistant Depression in Real-World Clinical Practice Settings Across Asia

Changsu Han,1 Gang Wang,2 Sandra Chan,3 Tadafumi Kato,4,5 Chee H Ng,6 Wilson Tan,7 Lili Zhang,8 Yu Feng,8 Chia-Yih Liu9 1Department of Psychiatry, Korea University College of Medicine, Seoul, South Korea; 2The National Clinical Research Center for Mental Disorder & Beijing Key Laboratory of Mental Disorders Beijing Anding Hospital & The Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, People’s Republic of China; 3Department of Psychiatry, The Chinese University of Hong Kong, Hong Kong, People’s Republic of China; 4RIKEN Center for Brain Science, Wako, Saitama, Japan; 5Department of Psychiatry and Behavioral Science, Juntendo University Graduate School of Medicine, Tokyo, Japan; 6Department of Psychiatry, The University of Melbourne, Melbourne, Victoria, Australia; 7Regional Medical Affairs, Janssen Pharmaceutical Companies of Johnson and Johnson, Singapore, Singapore; 8Medical Affairs, Xian Janssen Pharmaceutical Ltd, Beijing, People’s Republic of China; 9Department of Psychiatry, Chang Gung Medical Center and Chang Gung University School of Medicine, Taoyuan City, TaiwanCorrespondence: Chia-Yih LiuDepartment of Psychiatry, Chang Gung Medical Center and Chang Gung University School of Medicine, No. 5, Fuching Street, Guishan District, Taoyuan City, TaiwanTel +886-3-3281200 Ext 2439Email liucy752@cgmh.org.twWilson TanRegional Medical Affairs, Janssen Pharmaceutical Companies of Johnson and Johnson, 2 Science Park Drive, #07– 13, Ascent, Singapore Science Park 1, Singapore 118222, SingaporeTel +65-69187930Email wtan27@its.jnj.comPurpose: An Asia-Pacific expert consensus defined treatment-resistant depression (TRD) as failure of ≥ 2 antidepressants given at adequate doses for 6– 8 weeks during a major depressive episode. A survey examined how TRD was being diagnosed in real-world practices across Asia. An expert panel then interpreted the results and provided practical recommendations.Methods: Between March and July 2018, 246 clinicians from Hong Kong, Japan, Mainland China, South Korea, and Taiwan were surveyed on how they identified TRD patients according to their own definitions.Results: Most physicians described antidepressant failure as “no response” (79%) or “inadequate response” (82%); fewer chose “failure to achieve remission” (45%). About 40% did not routinely use clinical tools to assess response. Around 52% defined adequate dose target as achieving the label’s upper dose limit. About 58% would treat for 4– 8 weeks before determining antidepressant failure. Most (76%) required the ≥ 2 qualifying antidepressant failures to be from different classes. Approximately 60% considered antidepressant failure(s) from previous depressive episode(s) when diagnosing TRD.Conclusion: Considering the survey results, antidepressant failure can be defined as a failure to achieve remission, or more practically as < 50% improvement in depressive symptoms or inability to return to work/study, and confirmed with a clinical tool. TRD diagnosis also requires ≥ 2 qualifying antidepressant failures within the same depressive episode; from the same or different classes; and achieving at least the minimum effective antidepressant dose for 6– 8 weeks.Keywords: Asia, treatment-resistant depression, diagnosis, management