Affiliations 

  • 1 Department of Mood and Anxiety, Institute of Mental Health, Singapore
  • 2 Department of Psychiatry, Cipto Mangunkusumo Hospital, Jakarta Pusat, Indonesia
  • 3 Department of Psychological Medicine, National University Hospital, Singapore
  • 4 Department of Psychiatry, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
  • 5 Department of Psychiatry, Dr. Soetomo General Academic Hospital-Faculty of Medicine, Airlangga University, Surabaya, Indonesia
  • 6 Department of Psychiatry, Metro Psych Facility, Manila, Philippines
  • 7 Dr Soeharto Heerdjan Jakarta Mental Hospital, Jakarta, Indonesia
  • 8 Department of Psychiatry, Phramongkutklao Hospital, Bangkok, Thailand
  • 9 Department of Psychiatry, Makati Medical Center, Makati City, Philippines
  • 10 Department of Psychological Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
  • 11 Prasrimahabodhi Psychiatric Hospital, Ubon Ratchathani, Thailand
  • 12 Department of Psychiatry, Hospital Kuala Lumpur, Kuala Lumpur, Malaysia
Neuropsychiatr Dis Treat, 2022;18:2747-2757.
PMID: 36444218 DOI: 10.2147/NDT.S380792

Abstract

INTRODUCTION: Despite the abundance of literature on treatment-resistant depression (TRD), there is no universally accepted definition of TRD and available treatment pathways for the management of TRD vary across the Southeast Asia (SEA) region, highlighting the need for a uniform definition and treatment principles to optimize the management TRD in SEA.

METHODS: Following a thematic literature review and pre-meeting survey, a SEA expert panel comprising 13 psychiatrists with clinical experience in managing patients with TRD convened and utilized the RAND/UCLA Appropriateness Method to develop consensus-based recommendations on the appropriate definition of TRD and principles for its management.

RESULTS: The expert panel agreed that "pharmacotherapy-resistant depression" (PRD) is a more suitable term for TRD and defined it as "failure of two drug treatments of adequate doses, for 4-8 weeks duration with adequate adherence, during a major depressive episode". A stepwise treatment approach should be employed for the management of PRD - treatment strategies can include maximizing dose, switching to a different class, and augmenting or combining treatments. Non-pharmacological treatments, such as electroconvulsive therapy and repetitive transcranial magnetic stimulation, are also appropriate options for patients with PRD.

CONCLUSION: These consensus recommendations on the operational definition of PRD and treatment principles for its management can be adapted to local contexts in the SEA countries but should not replace clinical judgement. Individual circumstances and benefit-risk balance should be carefully considered while determining the most appropriate treatment option for patients with PRD.

* Title and MeSH Headings from MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.