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Treatment-Resistant Depression in Portugal: Perspective From Psychiatry Experts.

João M Bessa1,2,3, Serafim Carvalho4, Inês B Cunha5

  • 1School of Medicine, Life and Health Sciences Research Institute (ICVS), University of Minho, Braga and Guimarães, Portugal.

Frontiers in Psychiatry
|April 18, 2022
PubMed
Summary

Treatment-resistant depression (TRD) management in Portugal faces challenges due to limited guidance and access to care. Experts recommend personalized treatment strategies beyond conventional pharmacotherapy to improve outcomes for patients with major depressive disorder (MDD).

Keywords:
Portugalexpert opinionmajor depressive disorderpatient journeytreatment-resistant depression

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Area of Science:

  • Psychiatry
  • Clinical Psychology
  • Pharmacology

Background:

  • Major depressive disorder (MDD) prevalence is high in Portugal, with limited specific guidance for treatment-resistant depression (TRD).
  • TRD is defined as moderate to severe MDD episodes with inadequate response to two adequate antidepressant treatments.
  • Current TRD management in Portugal is constrained by restricted access to specialist care and diverse treatment modalities.

Purpose of the Study:

  • To characterize the epidemiology, diagnosis, patient journey, and treatment options for MDD and TRD in Portugal.
  • To identify unmet clinical needs in TRD management among Portuguese psychiatry experts.
  • To reach a consensus on key issues concerning TRD in the Portuguese context.

Main Methods:

  • A questionnaire survey was administered to gather data on TRD.
  • Two advisory boards were conducted with seven Portuguese psychiatry experts.
  • Consensus-building methodology was employed to discuss and define issues related to MDD and TRD.

Main Results:

  • TRD diagnosis and treatment decisions are primarily made by psychiatrists in public hospitals.
  • Treatment strategies must be individualized based on patient characteristics, episode history, comorbidities, and prior treatment responses.
  • Key treatment objectives include achieving response and remission, suicide prevention, and enhancing quality of life and functionality.

Conclusions:

  • Pharmacotherapy optimization, combination, and augmentation are crucial for patients with partial response to antidepressants.
  • Psychotherapy should be integrated with pharmacological treatment, and brain stimulation techniques are underutilized.
  • Lifelong treatment is often necessary for recurrent or chronic TRD, but patient adherence remains a challenge, highlighting the need for improved access and treatment options.