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Treatment‐resistant major depressive disorder: Canadian expert consensus on definition and assessment
Author(s) -
Rybak Yuri E.,
Lai Ka S. P.,
Ramasubbu Rajamannar,
VilaRodriguez Fidel,
Blumberger Daniel M.,
Chan Peter,
Delva Nicholas,
Giacobbe Peter,
Gosselin Caroline,
Kennedy Sidney H.,
Iskandar Hani,
McInerney Shane,
Ravitz Paula,
Sharma Verinder,
Zaretsky Ari,
Burhan Amer M.
Publication year - 2021
Publication title -
depression and anxiety
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.634
H-Index - 129
eISSN - 1520-6394
pISSN - 1091-4269
DOI - 10.1002/da.23135
Subject(s) - delphi method , psychology , treatment resistant depression , grading (engineering) , major depressive disorder , medicine , psychiatry , clinical psychology , cognition , statistics , mathematics , civil engineering , engineering
Abstract Background Treatment‐resistant depression (TRD) is a debilitating chronic mental illness that confers increased morbidity and mortality, decreases the quality of life, impairs occupational, social, and offspring development, and translates into increased costs on the healthcare system. The goal of this study is to reach an agreement on the concept, definition, staging model, and assessment of TRD. Methods This study involved a review of the literature and a modified Delphi process for consensus agreement. The Appraisal of Guidelines for Research & Evaluation II guidelines were followed for the literature appraisal. Literature was assessed for quality and strength of evidence using the grading, assessment, development, and evaluations system. Canadian national experts in depression were invited for the modified Delphi process based on their prior clinical and research expertize. Survey items were considered to have reached a consensus if 80% or more of the experts supported the statement. Results Fourteen Canadian experts were recruited for three rounds of surveys to reach a consensus on a total of 27 items. Experts agreed that a dimensional definition for treatment resistance was a useful concept to describe the heterogeneity of this illness. The use of staging models and clinical scales was recommended in evaluating depression. Risk factors and comorbidities were identified as potential predictors for treatment resistance. Conclusions TRD is a meaningful concept both for clinical practice and research. An operational definition for TRD will allow for opportunities to improve the validity of predictors and therapeutic options for these patients.