Management of Treatment-Resistant Depression in Real-World Clinical Practice Settings Across Asia

Abstract

Gang Wang,1,2 Changsu Han,3 Chia-Yih Liu,4 Sandra Chan,5 Tadafumi Kato,6,7 Wilson Tan,8 Lili Zhang,9 Yu Feng,9 Chee H Ng10 1The National Clinical Research Center for Mental Disorder & Beijing Key Laboratory of Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing, People’s Republic of China; 2Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, People’s Republic of China; 3Department of Psychiatry, Korea University College of Medicine, Seoul, South Korea; 4Department of Psychiatry, Chang Gung Medical Center, and Chang Gung University School of Medicine, Taoyuan City, Taiwan; 5Department of Psychiatry, The Chinese University of Hong Kong, Hong Kong, People’s Republic of China; 6RIKEN Center for Brain Science, Wako, Saitama, Japan; 7Department of Psychiatry and Behavioral Science, Juntendo University Graduate School of Medicine, Tokyo, Japan; 8Regional Medical Affairs, Janssen Pharmaceutical Companies of Johnson and Johnson, Singapore, Singapore; 9Medical Affairs, Xian Janssen Pharmaceutical Ltd, Beijing, People’s Republic of China; 10Department of Psychiatry, The University of Melbourne, Melbourne, Victoria, AustraliaCorrespondence: Chee H NgThe Melbourne Clinic, 130 Church Street, Richmond, Victoria 3121, AustraliaTel [phone]Fax [phone]Email [email protected] Tan Regional Medical AffairsJanssen Pharmaceutical Companies of Johnson and Johnson, 2 Science Park Drive, #07-13, Ascent, Singapore Science Park 1, 118222, SingaporeTel [phone]Email [email protected]: Consensus is lacking on the management of treatment-resistant depression (TRD), resulting in significant variations on how TRD patients are being managed in real-world practice. A survey explored how clinicians managed TRD across Asia, followed by an expert panel that interpreted the survey results and provided recommendations on how TRD could be managed in real-world clinical settings.Methods: Between March and July 2018, 246 clinicians from Hong Kong, Japan, Mainland China, South Korea, and Taiwan completed a survey related to their treatment approaches for TRD.Results: The survey showed physicians using more polytherapy (71%) compared to maintaining patients on monotherapy (29%). The most commonly (23%) administered polytherapy involved antidepressant augmentation with antipsychotics that 19% of physicians also indicated as their most important approach for managing TRD. The highest number of physicians (34%) ranked switching to another class of antidepressants as their most important approach, while 16% and 9% chose antidepressant combinations and electroconvulsive therapy (ECT), respectively.Conclusion: Taking into account the survey results, the expert panel made general recommendations on the management of TRD. TRD partial-responders to antidepressants should be considered for augmentation with second-generation antipsychotics. For non-responders, switching to another class of antidepressants ought to be considered. TRD patients achieving remission with acute treatment should consider continuing their antidepressants for at least another 6 months to prevent relapse. ECT is a treatment consideration for patients with severe depression or persistent symptoms despite multiple adequate trials of antidepressants. Physicians should also consider the response, tolerability and adherence to the current and previous antidepressants, the severity of symptoms, comorbidities, concomitant medications, preferences, and cost when choosing a TRD treatment approach for each individual patient.Keywords: Asia, treatment-resistant depression, diagnosis, management

Keywords

• asia
• treatment-resistant depression
• diagnosis
• management