Treatment‐resistant depression: definition, prevalence, detection, management, and investigational interventions

作者：Roger S. McIntyre, Mohammad Alsuwaidan, Bernhard T. Baune, Michael Berk, Koen Demyttenaere, Joseph F. Goldberg, Philip Gorwood, Roger Ho, Siegfried Kasper, Sidney H. Kennedy, Josefina T Ly-Uson, Rodrigo B. Mansur, R. Hamish McAllister‐Williams, James W. Murrough, Charles B. Nemeroff, Andrew A. Nierenberg, Joshua D. Rosenblat, Gerard Sanacora, Alan F. Schatzberg, Richard C. Shelton, Stephen M. Stahl, Madhukar H. Trivedi, Eduard Vieta, Maj Vinberg, Nolan Williams, Allan H. Young, Mario Maj · 发表于：World Psychiatry · 年份：2023 · DOI：10.1002/wps.21120 · 被引用次数：752 · 研究领域：Treatment of Major Depression、Electroconvulsive Therapy Studies、Transcranial Magnetic Stimulation Studies

Treatment-resistant depression (TRD) is common and associated with multiple serious public health implications. A consensus definition of TRD with demonstrated predictive utility in terms of clinical decision-making and health outcomes does not currently exist. Instead, a plethora of definitions have been proposed, which vary significantly in their conceptual framework. The absence of a consensus definition hampers precise estimates of the prevalence of TRD, and also belies efforts to identify risk factors, prevention opportunities, and effective interventions. In addition, it results in heterogeneity in clinical practice decision-making, adversely affecting quality of care. The US Food and Drug Administration (FDA) and the European Medicines Agency (EMA) have adopted the most used definition of TRD (i.e., inadequate response to a minimum of two antidepressants despite adequacy of the treatment trial and adherence to treatment). It is currently estimated that at least 30% of persons with depression meet this definition. A significant percentage of persons with TRD are actually pseudo-resistant (e.g., due to inadequacy of treatment trials or non-adherence to treatment). Although multiple sociodemographic, clinical, treatment and contextual factors are known to negatively moderate response in persons with depression, very few factors are regarded as predictive of non-response across multiple modalities of treatment. Intravenous ketamine and intranasal esketamine (co-administere...