Han Changsu, Wang Gang, Chan Sandra, Kato Tadafumi, Ng Chee H, Tan Wilson, Zhang Lili, Feng Yu, Liu Chia-Yih
Department of Psychiatry, Korea University College of Medicine, Seoul, South Korea.
The National Clinical Research Center for Mental Disorder & Beijing Key Laboratory of Mental Disorders Beijing Anding Hospital & The Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, People's Republic of China.
Neuropsychiatr Dis Treat. 2020 Dec 3;16:2929-2941. doi: 10.2147/NDT.S264799. eCollection 2020.
An Asia-Pacific expert consensus defined treatment-resistant depression (TRD) as failure of ≥2 antidepressants given at adequate doses for 6-8 weeks during a major depressive episode. A survey examined how TRD was being diagnosed in real-world practices across Asia. An expert panel then interpreted the results and provided practical recommendations.
Between March and July 2018, 246 clinicians from Hong Kong, Japan, Mainland China, South Korea, and Taiwan were surveyed on how they identified TRD patients according to their own definitions.
Most physicians described antidepressant failure as "no response" (79%) or "inadequate response" (82%); fewer chose "failure to achieve remission" (45%). About 40% did not routinely use clinical tools to assess response. Around 52% defined adequate dose target as achieving the label's upper dose limit. About 58% would treat for 4-8 weeks before determining antidepressant failure. Most (76%) required the ≥2 qualifying antidepressant failures to be from different classes. Approximately 60% considered antidepressant failure(s) from previous depressive episode(s) when diagnosing TRD.
Considering the survey results, antidepressant failure can be defined as a failure to achieve remission, or more practically as <50% improvement in depressive symptoms or inability to return to work/study, and confirmed with a clinical tool. TRD diagnosis also requires ≥2 qualifying antidepressant failures within the same depressive episode; from the same or different classes; and achieving at least the minimum effective antidepressant dose for 6-8 weeks.
亚太地区专家共识将难治性抑郁症（TRD）定义为在重度抑郁发作期间，≥2种抗抑郁药足量使用6 - 8周仍治疗失败。一项调查研究了亚洲各地实际临床实践中TRD的诊断方式。随后一个专家小组对结果进行了解读并给出了实用建议。
2018年3月至7月间，对来自中国香港、日本、中国大陆、韩国和台湾的246名临床医生进行了调查，询问他们如何根据自己的定义识别TRD患者。
大多数医生将抗抑郁药治疗失败描述为“无反应”（79%）或“反应不足”（82%）；较少有人选择“未达到缓解”（45%）。约40%的医生不常规使用临床工具评估反应。约52%的医生将足量剂量目标定义为达到药品标签上的剂量上限。约58%的医生会在确定抗抑郁药治疗失败前治疗4 - 8周。大多数（76%）要求≥2次符合条件的抗抑郁药治疗失败来自不同类别。约60%的医生在诊断TRD时会考虑既往抑郁发作时的抗抑郁药治疗失败情况。
综合调查结果，抗抑郁药治疗失败可定义为未达到缓解，或更实际地定义为抑郁症状改善不足50%或无法恢复工作/学习，并通过临床工具确认。TRD的诊断还要求在同一抑郁发作期间有≥2次符合条件的抗抑郁药治疗失败；来自相同或不同类别；且至少达到最低有效抗抑郁药剂量并持续6 - 8周。
