New International Consensus Statement Proposes “Difficult-to-treat Depression” as a More Clinically Useful Definition than “Treatment-Resistant Depression”
The international consensus group, comprised of psychiatrists from around the globe, reviewed relevant literature on TRD and DTD. They identified and consented on terminology describing DTD, information about the identification and assessment of patients with DTD, and treatment options for DTD. They proposed the definition of DTD as “depression that continues to cause significant burden despite usual treatment efforts.”
“Reconceptualizing ‘Treatment-Resistant Depression’ as ‘Difficult-to-treat’ is significant for many reasons. Describing a person’s depression as ‘treatment resistant’ can often simply increase their sense of hopelessness. It can also be used by some clinicians as a way of absolving themselves of their inability to help the person recover from their illness. Conversely, describing depression as ‘difficult to treat’ helps move the clinician and patient into a more proactive, multi-dimensional framework, identifying addressable barriers to successful treatment and considering a broad range of treatment options,” said Prof.
The consensus paper explains that focusing on steps in the treatment pathway provides greater scope for addressing factors that could influence DTD patient outcomes. Recommended key principles in the treatment pathway include: a thorough initial assessment after identifying a patient as having DTD and long-term follow-up assessments at regular intervals; the use of a framework to facilitate identification of barriers to successful treatment; a patient-centered approach based on shared decision making around all aspects of treatment; and optimizing medication choices and doses for each patient, along with specific psychosocial interventions in order to achieve optimal symptom control.
“LivaNova is committed to helping people for whom depression remains a significant burden despite conventional treatment. This consensus statement emphasizes a more empathetic and multi-modal assessment and treatment approach,” said
While the costs of a consensus meeting were met through an unrestricted educational grant made available by
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R.H. McAllister-Williams, C. Arango, P. Blier, K. Demyttenaere, P. Falkai, P. Gorwood, M. Hopwood, A. Javed, S. Kasper, G.S. Malhi, J.C. Soares, E. Vieta, A.H. Young, A. Papadopoulos, A.J. Rush, The identification, assessment and management of difficult-to-treat depression: An international consensus statement, Journal of Affective Disorders(2020), doi: https://doi.org/10.1016/j.jad.2020.02.023.
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