Definition of treatment-resistant depression – Asia Pacific perspectives

Ng, Chee H.; Kato, Takeshi; Han, Chongyang; Wang, G.; Trivedi, Madhukar H.; Ramesh, V; Шао, Ди; Gala, Shalin G.; Narayanan, S.; Tan, Wilson M.; Feng, Yu; Kasper, Siegfried

doi:10.1016/j.jad.2018.11.038

Cited by 44 publications

(53 citation statements)

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“…The subjectivity of assessments (like "sufficient", "ineffective", "satisfactory" and "poor") is likely to aggravate further the already lack of a standard TRD definition recognized by the survey participants. 16 Hence, in addition to developing a consensus on TRD definition, it is also important to standardize how TRD patients are being identified practically in the realworld clinical setting, in-line with the TRD definition.…”

Section: Discussionmentioning

confidence: 99%

“…14,15 A systematic review of the published literature between 2010 and 2016 also revealed inconsistencies in the definition of TRD in both clinical and research settings in the Asia-Pacific region. 16 The authors of the review eventually arrived at a consensus on the definition of TRD: failure of at least two antidepressant trials, given at adequate doses, for 6-8 weeks while ensuring adequate treatment adherence, during an MDD episode. It remains unknown whether such a definition is consistent with or can be implemented in real-world clinical settings across Asia.…”

Section: Introductionmentioning

confidence: 99%

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<p>Definition and Identification of Patients with Treatment-Resistant Depression in Real-World Clinical Practice Settings Across Asia</p>

Han¹,

Wang²,

Chan³

et al. 2020

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Purpose: 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. Methods: 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. Results: 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. Conclusion: 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.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

<p>Definition and Identification of Patients with Treatment-Resistant Depression in Real-World Clinical Practice Settings Across Asia</p>

Han¹,

Wang²,

Chan³

et al. 2020

NDT

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“…Potential patients will be enrolled from the Tianjin Mental Health Center affiliated with Tianjin Medical University in Tianjin, a coastal metropolis in northern China with approximately 13,000,000 residents. Eligible patients will (a) be aged 18–65 years to minimize potential older age‐related confounding effects, such as AD and cognitive impairment; (b) meet the Diagnostic and Statistical Manual of Mental Disorders fifth edition criteria for recurrent MDD without psychotic features, which will be confirmed using the Mini International Neuropsychiatric Interview (Sheehan et al, ; Singh et al, ); (c) have inadequate responses to at least two antidepressant medications, with at least one antidepressant failure to treat current depressive episodes, as evaluated by medical histories, the Massachusetts General Hospital Antidepressant Response Questionnaire, and Montgomery‐Asberg Depression Rating Scale (MADRS) score ≥21 at baseline (Chandler, Iosifescu, Pollack, Targum, & Fava, ; Ng et al, ; Singh et al, ); (d) be willing to participate and fully cooperate in this study; and (e) provide written informed consent prior to study participation. Patients with the following conditions will be considered to be ineligible and will be excluded from the study: (a) severe systemic disease; (b) epilepsy, claustrophobia, primary obsessive–compulsive disorder, anorexia nervosa, bulimia nervosa, or posttraumatic stress disorder; (c) medical history or current diagnosis of a psychotic disorder; (d) medical history or current diagnosis of mental retardation, bipolar disorder, mood disorder with postpartum onset, borderline personality disorder, or somatoform disorder; (e) hypertension or vascular disease, including aneurysm, vascular malformation, thrombosis, and neoplasm; (f) unfitness for MRI, including the presence of a magnetic implant; (g) unfitness for PET, including allergy to PET tracers; (h) substance abuse; (i) use of medicine for a sleep disorder; (j) medical history of nonresponsiveness of depressive symptoms to ketamine; (k) clinically significant suicidal or homicidal ideation or imminent risk of harm; and (l) current pregnancy or breastfeeding status.…”

Section: Methods and Study Designmentioning

confidence: 99%

“…The design of this study is illustrated in Figure 1. Rating Scale (MADRS) score ≥21 at baseline (Chandler, Iosifescu, Pollack, Targum, & Fava, 2010;Ng et al, 2019;Singh et al, 2016);…”

Section: Me Thods and S Tudy De S I G Nmentioning

confidence: 99%

Effects of ketamine on circadian rhythm and synaptic homeostasis in patients with treatment‐resistant depression: A protocol for mechanistic studies of its rapid and sustained antidepressant actions in humans

Zhuo

Tian

et al. 2019

Brain and Behavior

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BackgroundThe breakthrough discovery has been made that a single dose of ketamine, an N‐methyl‐D‐aspartate receptor antagonist, achieves rapid and sustained (~7 days) antidepressant activity in patients with major depressive disorder (MDD). This discovery has ushered in an exciting era of research and brought new hope for patients with MDD. However, the mechanisms underlying the specific antidepressant actions of ketamine in humans remain to be elucidated.ObjectivesThis study protocol was designed to test the main hypothesis that ketamine could rapidly reverse depression‐ and stress‐associated synaptic loss and deficits in resting‐state functional connectivity and that this action could be affected by circadian rhythm, in patients with treatment‐resistant depression.Methods/Study DesignIn this clinical study, adults (aged 18–65 years) with treatment‐resistant depression will be randomized to intravenous administration of placebo (control group) or ketamine (0.5 mg/kg body weight) at 11 a.m. (daytime group), or 6 p.m. (nighttime group) for 24 weeks. The primary outcome will be the change from baseline to 24 weeks in the total Montgomery‐Asberg Depression Rating Scale score. Brain imaging, sleep, and genetic studies, including functional magnetic resonance imaging, positron emission tomography, polysomnography, and genetic analyses, will be performed to examine whether and how ketamine can rapidly reverse deficits in synaptic function and to identify objective markers for the assessment of ketamine infusion therapy for treatment‐resistant depression.ConclusionsThis clinical study protocol is the first, to our knowledge, to describe the prospective testing of the hypothesis that daytime and nighttime administrations of ketamine would have different antidepressant effects. The brain imaging, sleep, and genetic findings from patients with treatment‐resistant depression are expected to shed new light on the mechanisms of ketamine and its interaction with target sites in the brain, which can be used for objective evaluation of the efficacy of ketamine.

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“…Im Jahre 2018 erschienen weltweit mehrere Publikationen, die die Problematik der fehlenden einheitlichen Definition der therapieresistenten Depression ansprechen und Definitionen vorschlagen. Eine Expertengruppe aus mehreren asiatischen und pazifischen Ländern führte eine systematische Analyse der Literatur zu Definitionen von therapieresistenten Depression durch [15]. Die Analyse identifizierte das Scheitern von ≥ 2 antidepressiven Therapien bei adäquater Dosierung über 6-8 Wochen innerhalb einer depressiven Episode als die häufigste Definition von therapieresistenter Depression.…”

Section: Indikationunclassified

Vagusnervstimulation bei affektiven Störungen

Dibué-Adjei

Kamp

Vogelsang

et al. 2020

Fortschr Neurol Psychiatr

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ZusammenfassungVagusnervstimulation (VNS) ist ein minimalinvasives Neurostimulationsverfahren und wurde 1994 in Europa für die Behandlung von Kindern und Erwachsenen mit medikamentenresistenten Epilepsien zugelassen. Die Beobachtung, dass sich Depressionen, die häufigste Komorbidität der Epilepsie, signifikant unter VNS verbesserten, initiierte Studien der VNS bei Patienten mit therapieresistenten Depressionen (TRD), die 2001 zu der europäischen Zulassung der VNS für TRD führten. Heutzutage ist in Deutschland der Einsatz der VNS für TRD-Patienten auf wenige hochspezialisierte (oft universitäre) Zentren limitiert und das Verfahren in der psychiatrischen Praxis weitestgehend unbekannt. In dieser systematischen Übersicht identifizieren und diskutieren wir deshalb die aktuellsten Studien zu VNS bei TRD sowie Empfehlungen von Fachgesellschaften und diskutieren den Einsatz der VNS in der klinischen Praxis. In den letzten fünf Jahren wurden fünf Studien mit Evidenzgrad 2 und vier Studien mit Evidenzgrad 3 zu der Wirkung von VNS bei TRD-Patienten publiziert. Kurzfristige Wirksamkeit der VNS konnte in klinischen Studien nicht gezeigt werden. Mehrere Studien demonstrieren die Langzeitwirksamkeit der VNS. Die kürzlich publizierte größte Untersuchung der Thematik bestätigt signifikant bessere Behandlungsergebnisse bei Patienten, die eine Zusatztherapie mit VNS erhielten – im Vergleich zu Patienten, die nur Behandlung nach Goldstandard über fünf Jahre erhielten. Die langfristige Wirksamkeit der VNS bei TRD-Patienten ist mit Evidenz des Grades 2 belegt, jedoch ist es unklar, welche TRD-Patienten die höchste Wahrscheinlichkeit eines Ansprechens auf VNS haben, was die Patientenselektion in der Praxis erschweren kann. Zusätzlich wirkt sich möglicherweise die unklare und variable Definition der therapieresistenten Depression problematisch auf den rechtzeitigen Einsatz von Neurostimulationsverfahren aus.

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Definition of treatment-resistant depression – Asia Pacific perspectives

Cited by 44 publications

References 83 publications

<p>Definition and Identification of Patients with Treatment-Resistant Depression in Real-World Clinical Practice Settings Across Asia</p>

<p>Definition and Identification of Patients with Treatment-Resistant Depression in Real-World Clinical Practice Settings Across Asia</p>

Effects of ketamine on circadian rhythm and synaptic homeostasis in patients with treatment‐resistant depression: A protocol for mechanistic studies of its rapid and sustained antidepressant actions in humans

Vagusnervstimulation bei affektiven Störungen

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