Overview of treatment-resistant depression.
Progress in brain research – January 01, 2023
Source: PubMed
Summary
Treatment-resistant depression (TRD) affects nearly one-third of patients with major depressive disorder, leading to significantly lower quality of life and increased healthcare costs. Individuals with TRD experience 40% more functional impairment and productivity loss compared to those without it. Despite its prevalence, a lack of consensus on TRD definitions hampers effective treatment comparisons. Current options for managing TRD include established pharmacological strategies, psychotherapeutic interventions, and innovative approaches like neurostimulation and glutamatergic compounds, yet guidelines remain limited compared to those for non-resistant depression.
Abstract
Patients with major depressive disorder (MDD) often exhibit an inadequate treatment response or failure to achieve remission following treatment with antidepressant drugs. Treatment-resistant depression (TRD) is proposed to identify this clinical scenario. Compared to those without TRD, patients with TRD have significantly lower health-related quality of life in mental and physical dimensions, more functional impairment and productivity loss, and higher healthcare costs. TRD imposes a massive burden on the individual, family, and society. However, a lack of consensus on the TRD definition limits the comparison and interpretation of TRD treatment efficacy across trials. Furthermore, because of the various TRD definitions, there is scarce treatment guideline specifically for TRD, in contrast to the rich treatment guidelines for MDD. In this chapter, common issues related to TRD, such as proper definitions of an adequate antidepressant trial and TRD, were carefully reviewed. Prevalence of and clinical outcomes related to TRD were summarized. We also summarized the staging models ever proposed for the diagnosis of TRD. Furthermore, we highlighted variations in the definition regarding the lack of or an inadequate response in treatment guidelines for depression. Up-to-date treatment options for TRD, including pharmacological strategies, psychotherapeutic interventions, neurostimulation techniques, glutamatergic compounds, and even experimental agents were reviewed.