Skip to Main content Skip to Navigation
Journal articles

The identification, assessment and management of difficult-to-treat depression: An international consensus statement

Abstract : Background: Many depressed patients are not able to achieve or sustain symptom remission despite serial treatment trials - often termed "treatment resistant depression". A broader, perhaps more empathic concept of "difficult-to-treat depression" (DTD) was considered. Methods: A consensus group discussed the definition, clinical recognition, assessment and management implications of the DTD heuristic. Results: The group proposed that DTD be defined as "depression that continues to cause significant burden despite usual treatment efforts". All depression management should include a thorough initial assessment. When DTD is recognized, a regular reassessment that employs a multi-dimensional framework to identify addressable barriers to successful treatment (including patient-, illness- and treatment-related factors) is advised, along with specific recommendations for addressing these factors. The emphasis of treatment, in the first instance, shifts from a goal of remission to optimal symptom control, daily psychosocial functional and quality of life, based on a patient-centred approach with shared decision-making to enhance the timely consideration of all treatment options (including pharmacotherapy, psychotherapy, neurostimulation, etc.) to optimize outcomes when sustained remission is elusive. Limitations: The recommended definition and management of DTD is based largely on expert consensus. While DTD would seem to have clinical utility, its specificity and objectivity may be insufficient to define clinical populations for regulatory trial purposes, though DTD could define populations for service provision or phase 4 trials. Conclusions: DTD provides a clinically useful conceptualization that implies a search for and remediation of specific patient-, illness- and treatment obstacles to optimizing outcomes of relevance to patients.
Document type :
Journal articles
Complete list of metadata

Cited literature [162 references]  Display  Hide  Download

https://www.hal.inserm.fr/inserm-02971283
Contributor : Clara Martinez Rico Connect in order to contact the contributor
Submitted on : Monday, October 19, 2020 - 12:57:00 PM
Last modification on : Wednesday, November 3, 2021 - 6:05:35 AM
Long-term archiving on: : Wednesday, January 20, 2021 - 6:40:35 PM

File

McAllister-Williams et al J Af...
Publication funded by an institution

Identifiers

Collections

Citation

R Mcallister-Williams, C. Arango, P. Blier, K. Demyttenaere, P. Falkai, et al.. The identification, assessment and management of difficult-to-treat depression: An international consensus statement. Journal of Affective Disorders, Elsevier, 2020, 267, pp.264-282. ⟨10.1016/j.jad.2020.02.023⟩. ⟨inserm-02971283⟩

Share

Metrics

Record views

53

Files downloads

278