Treatment-resistant and multi-therapy-resistant criteria for bipolar depression: consensus definition

Area of Science:

• Psychiatry and Mental Health
• Neuroscience
• Clinical Therapeutics

Background:

• Bipolar disorder frequently involves significant depressive symptoms, leading to high disability and mortality.
• Limited treatment options for bipolar depression contribute to treatment resistance.
• Existing definitions for treatment-resistant bipolar depression (TRBD) and multi-therapy-resistant bipolar depression (MTRBD) lack comprehensive criteria.

Purpose of the Study:

• To establish consensus-based threshold definitions for TRBD.
• To establish consensus-based threshold definitions for MTRBD.

Main Methods:

• A modified Delphi method was employed, involving a panel of bipolar disorder experts.
• Criteria were developed based on evidence from current bipolar disorder treatment guidelines.
• Consensus was reached on specific definitions for TRBD and MTRBD.

Main Results:

• TRBD is defined as failure to achieve sustained remission (8 weeks) after two treatment trials at adequate doses, including specific monotherapy or combination treatments.
• MTRBD includes the TRBD definition plus failure of at least one trial each of an antidepressant, psychological treatment, and electroconvulsive therapy.
• These criteria provide a framework for identifying patients who may benefit from novel or non-standard treatments.

Conclusions:

• The proposed TRBD and MTRBD criteria offer a standardized approach for clinicians and researchers.
• These definitions can aid in decision-making regarding the consideration of new treatment modalities.
• Further research is needed to address identified diagnostic and therapeutic challenges.