Neuropsychiatric Disease and Treatment (Nov 2022)

A Southeast Asia Consensus on the Definition and Management of Treatment-Resistant Depression

  • Tor PC,
  • Amir N,
  • Fam J,
  • Ho R,
  • Ittasakul P,
  • Maramis MM,
  • Ponio B,
  • Purnama DA,
  • Rattanasumawong W,
  • Rondain E,
  • Bin Sulaiman AH,
  • Wiroteurairuang K,
  • Chee KY

Journal volume & issue
Vol. Volume 18
pp. 2747 – 2757

Abstract

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Phern Chern Tor,1 Nurmiati Amir,2 Johnson Fam,3 Roger Ho,3 Pichai Ittasakul,4 Margarita M Maramis,5 Benita Ponio,6 Dharmawan Ardi Purnama,7 Wanida Rattanasumawong,8 Elizabeth Rondain,9 Ahmad Hatim Bin Sulaiman,10 Kannokarn Wiroteurairuang,11 Kok Yoon Chee12 1Department of Mood and Anxiety, Institute of Mental Health, Singapore; 2Department of Psychiatry, Cipto Mangunkusumo Hospital, Jakarta Pusat, Indonesia; 3Department of Psychological Medicine, National University Hospital, Singapore; 4Department of Psychiatry, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand; 5Department of Psychiatry, Dr. Soetomo General Academic Hospital-Faculty of Medicine, Airlangga University, Surabaya, Indonesia; 6Department of Psychiatry, Metro Psych Facility, Manila, Philippines; 7Dr Soeharto Heerdjan Jakarta Mental Hospital, Jakarta, Indonesia; 8Department of Psychiatry, Phramongkutklao Hospital, Bangkok, Thailand; 9Department of Psychiatry, Makati Medical Center, Makati City, Philippines; 10Department of Psychological Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia; 11Prasrimahabodhi Psychiatric Hospital, Ubon Ratchathani, Thailand; 12Department of Psychiatry, Hospital Kuala Lumpur, Kuala Lumpur, MalaysiaCorrespondence: Ahmad Hatim Bin Sulaiman, Department of Psychological Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, 50603, Malaysia, Email [email protected]: Despite the abundance of literature on treatment-resistant depression (TRD), there is no universally accepted definition of TRD and available treatment pathways for the management of TRD vary across the Southeast Asia (SEA) region, highlighting the need for a uniform definition and treatment principles to optimize the management TRD in SEA.Methods: Following a thematic literature review and pre-meeting survey, a SEA expert panel comprising 13 psychiatrists with clinical experience in managing patients with TRD convened and utilized the RAND/UCLA Appropriateness Method to develop consensus-based recommendations on the appropriate definition of TRD and principles for its management.Results: The expert panel agreed that “pharmacotherapy-resistant depression” (PRD) is a more suitable term for TRD and defined it as “failure of two drug treatments of adequate doses, for 4– 8 weeks duration with adequate adherence, during a major depressive episode”. A stepwise treatment approach should be employed for the management of PRD – treatment strategies can include maximizing dose, switching to a different class, and augmenting or combining treatments. Non-pharmacological treatments, such as electroconvulsive therapy and repetitive transcranial magnetic stimulation, are also appropriate options for patients with PRD.Conclusion: These consensus recommendations on the operational definition of PRD and treatment principles for its management can be adapted to local contexts in the SEA countries but should not replace clinical judgement. Individual circumstances and benefit-risk balance should be carefully considered while determining the most appropriate treatment option for patients with PRD.Keywords: depression, pharmacotherapy, major depressive disorder, anti-depressive agents, depressive disorder – treatment resistant

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