Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Taiwan; School of Medicine and Institute of Brain Science, National Yang Ming Chiao Tung University, Taipei, Taiwan.
Prog Brain Res. 2023;278:1-23. doi: 10.1016/bs.pbr.2023.03.007. Epub 2023 May 15.
Patients with major depressive disorder (MDD) often exhibit an inadequate treatment response or failure to achieve remission following treatment with antidepressant drugs. Treatment-resistant depression (TRD) is proposed to identify this clinical scenario. Compared to those without TRD, patients with TRD have significantly lower health-related quality of life in mental and physical dimensions, more functional impairment and productivity loss, and higher healthcare costs. TRD imposes a massive burden on the individual, family, and society. However, a lack of consensus on the TRD definition limits the comparison and interpretation of TRD treatment efficacy across trials. Furthermore, because of the various TRD definitions, there is scarce treatment guideline specifically for TRD, in contrast to the rich treatment guidelines for MDD. In this chapter, common issues related to TRD, such as proper definitions of an adequate antidepressant trial and TRD, were carefully reviewed. Prevalence of and clinical outcomes related to TRD were summarized. We also summarized the staging models ever proposed for the diagnosis of TRD. Furthermore, we highlighted variations in the definition regarding the lack of or an inadequate response in treatment guidelines for depression. Up-to-date treatment options for TRD, including pharmacological strategies, psychotherapeutic interventions, neurostimulation techniques, glutamatergic compounds, and even experimental agents were reviewed.
患有重度抑郁症（MDD）的患者在接受抗抑郁药物治疗后，常常表现出治疗反应不足或无法缓解。治疗抵抗性抑郁症（TRD）被提出用于识别这种临床情况。与没有 TRD 的患者相比，TRD 患者在心理和身体维度的健康相关生活质量明显较低，功能障碍和生产力损失更多，医疗保健费用更高。TRD 给个人、家庭和社会带来了巨大的负担。然而，由于对 TRD 定义缺乏共识，限制了临床试验之间对 TRD 治疗效果的比较和解释。此外，由于各种 TRD 定义，针对 TRD 的治疗指南相对较少，而针对 MDD 的治疗指南则很丰富。在这一章中，我们仔细审查了与 TRD 相关的常见问题，例如适当的抗抑郁药试验和 TRD 的定义。总结了 TRD 的患病率和相关临床结局。我们还总结了曾经提出的用于诊断 TRD 的分期模型。此外，我们强调了抑郁症治疗指南中缺乏或治疗反应不足的定义差异。我们回顾了 TRD 的最新治疗选择，包括药物策略、心理治疗干预、神经刺激技术、谷氨酸化合物，甚至实验药物。
