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Defining treatment-resistant depression.

Bradley N Gaynes1, Linda Lux2, Gerald Gartlehner2,3

  • 1Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.

Depression and Anxiety
|October 23, 2019
PubMed
Summary
This summary is machine-generated.

No consensus definition exists for treatment-resistant depression (TRD), hindering clinical guidelines. Standardizing TRD definitions and outcome measures is crucial for advancing research and improving patient care.

Keywords:
consensusdefinitionguidelineinterventionsystematic reviewtreatment-resistant depression

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Area of Science:

  • Psychiatry
  • Clinical Research Methodology

Background:

  • Varying conceptualizations of treatment-resistant depression (TRD) complicate the translation of research into clinical practice guidelines.
  • Inconsistent definitions hinder the development of standardized treatment protocols and evidence-based care.

Purpose of the Study:

  • To clarify expert and investigator definitions of TRD.
  • To systematically review the alignment of TRD definitions in clinical trials with expert consensus.

Main Methods:

  • Conducted a review for the Centers for Medicare & Medicaid Services and the Agency for Healthcare Research and Quality.
  • Systematically reviewed clinical trial definitions of TRD up to July 5, 2019.

Main Results:

  • No consensus definition for TRD was identified.
  • Common definitions required 1-2 prior treatment failures, but adequacy of dose/duration lacked consensus.
  • Only 17% of studies met the most common TRD criteria; functional impairment and quality-of-life measures were rarely used.

Conclusions:

  • Developing a consensus definition for TRD, including prior treatment failures and adequacy of dose/duration, is critical.
  • Establishing a core package of standardized outcome measures is essential for advancing TRD research.
  • Improved research design and conduct will lead to clearer clinical guidelines for treating TRD.