The burden associated with, and management of, difficult-to-treat depression in patients under specialist psychiatric care in the United Kingdom

Abstract

Background: Major depressive disorder (MDD) is common and often has sub-optimal response to treatment. Difficult-to-treat depression (DTD) is a new concept that describes ‘depression that continues to cause significant burden despite usual treatment efforts’. Aims: To identify patients with likely DTD in UK secondary care and examine demographic, disease and treatment data as compared with ‘non-DTD’ MDD patients. Methods: Anonymised electronic health records (EHRs) of five specialist mental health National Health Service (NHS) Trusts in the United Kingdom were analysed using a natural language processing model. Data on disease characteristics, comorbidities and treatment histories were extracted from structured fields and using natural language algorithms from unstructured fields. Patients with MDD aged ⩾18 years were included in the analysis; those with presumed DTD were identified on the basis of MDD history (duration and recurrence) and number of treatments prescribed. Results: In a sample of 28,184 patients with MDD, 19% met criteria for DTD. Compared to the non-DTD group, patients with DTD were more likely to have severe depression, suicidal ideation, and comorbid psychiatric and/or physical illness, as well as higher rates of hospitalisation. They were also more likely to be in receipt of unemployment and sickness/disability benefits. More intensive treatment strategies were used in the DTD group, including higher rates of combination therapy, augmentation, psychotherapy and electroconvulsive therapy. Conclusion: This study demonstrates the feasibility of identifying patients with probable DTD from EHRs and highlights the increased burden associated with MDD in these patients.

Treatment‐resistant depression: definition, prevalence, detection, management, and investigational interventions

“…The related, but separate, notion of DTD seems more aligned with the realities of the clinical ecosystem, and with patient experience of depression and sequential non-response to treatments 94,286 . A compelling case is made that TRD is potentially judgmental insofar as it may be interpreted as blaming the patient.…”

Peer-led intervention for individuals with major depression: study protocol for a randomized controlled trial (SUPEERMood)

“…There are other second-line neuromodulator antidepressant therapeutic alternatives, but their availability and acceptance by patients vary greatly (10,11). Despite these options, a signi cant number of individuals with MDD have a poor prognosis due to di culties in diagnosis, limited access to effective treatments, and frequent unsatisfactory responses (12). Furthermore, around one-third of individuals diagnosed with MDD exhibit non-response to conventional antidepressant interventions, thus manifesting treatment-resistant depression (13).…”

The psychopharmacology of mood disorders

“…The original articles lead off with a paper by Costa et al (2022), which examines the burden associated with, and management of, difficult-to-treat depression (DTD) in patients under specialist psychiatric care in the United Kingdom. Anonymised electronic health records (EHRs) of five specialist mental health National Health Service Trusts in the United Kingdom were analysed using a natural language processing model.…”