Phern Chern Tor and Nurmiati Amir and Johnson Fam and Roger Ho and Pichai Ittasakul and Margarita M Maramis and Benita Ponio and Dharmawan Ardi Purnama and Wanida Rattanasumawong and Elizabeth Rondain and Ahmad Hatim Bin Sulaiman and Kannokarn Wiroteurairuang and Kok Yoon Chee (2022) A Southeast Asia Consensus on the Definition and Management of Treatment-Resistant Depression. Neuropsychiatric Disease and Treatment, 18. pp. 2747-2757. ISSN 1178-2021

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Abstract

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.

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