Department of Psychiatry, University of Melbourne, Victoria, Australia.
RIKEN Brain Science Institute, Saitama, Japan.
J Affect Disord. 2019 Feb 15;245:626-636. doi: 10.1016/j.jad.2018.11.038. Epub 2018 Nov 5.
The lack of uniformity in the definition of treatment resistant depression (TRD) within the Asia-Pacific (APAC) region may have implications for patient management. We aimed to characterize the most commonly used TRD definition in selected APAC countries.
A systematic literature review of TRD definitions in APAC countries was conducted in Medline and Embase (2010-2016) and conference proceedings (2014 and 2016). TRD guidelines (APAC, Europe regional, US, or international) were also searched. An expert-panel explored APAC nuances in TRD definitions to achieve consensus for a regional-level definition.
Ten guidelines and 89 studies qualified for study inclusion. Among the studies, variations were observed in definitions regarding: number of antidepressants failed (range: ≥1 to ≥3), classes of antidepressants (same or different; 59% did not specify class), duration of previous treatments (range: 4-12 weeks), dosage adequacy, and consideration of adherence (yes/no; 88% of studies did not consider adherence). No TRD-specific guidelines were identified. The emerging consensus from the literature review and panel discussion was that TRD is most commonly defined as failure to ≥2 antidepressant therapies given at adequate doses, for 6-8 weeks during a major depressive episode.
Few studies provided definitions of TRD used in daily clinical practice, and a limited number of countries were represented in the included studies and expert panel.
Attaining consensus on TRD definition may promote accurate, and possibly early detection of patients with TRD to enable appropriate intervention that may impact patient outcomes and quality of life.
亚太地区（APAC）治疗抵抗性抑郁症（TRD）的定义缺乏一致性，这可能对患者管理产生影响。我们旨在描述在选定的亚太国家中最常用的 TRD 定义。
对 2010 年至 2016 年期间 Medline 和 Embase 中的 APAC 国家的 TRD 定义进行了系统文献回顾，并检索了亚太、欧洲、美国或国际 TRD 指南。专家小组探讨了 TRD 定义中的亚太细微差别，以达成区域层面定义的共识。
有 10 项指南和 89 项研究符合纳入标准。在这些研究中，关于失败的抗抑郁药数量（范围：≥1 至≥3）、抗抑郁药类别（相同或不同；59%未指定类别）、先前治疗的持续时间（范围：4-12 周）、剂量充足性和对依从性的考虑（是/否；88%的研究不考虑依从性），观察到定义存在差异。未确定特定于 TRD 的指南。文献回顾和小组讨论得出的共识是，TRD 最常定义为在重度抑郁发作期间，给予足够剂量的≥2 种抗抑郁药治疗 6-8 周而失败。
很少有研究提供了在日常临床实践中使用的 TRD 定义，并且纳入的研究和专家小组中代表的国家数量有限。
就 TRD 定义达成共识可能会促进对 TRD 患者的准确、可能早期检测，从而进行适当的干预，可能会影响患者的结局和生活质量。
