Abstract
BackgroundClear guidance for successive antidepressant pharmacological treatments for non-responders in major depression is not well established.MethodBased on the RAND/UCLA Appropriateness Method, the French Association for Biological Psychiatry and Neuropsychopharmacology and the fondation FondaMental developed expert consensus guidelines for the management of treatment-resistant depression. The expert guidelines combine scientific evidence and expert clinicians’ opinions to produce recommendations for treatment-resistant depression. A written survey comprising 118 questions related to highly-detailed clinical presentations was completed on a risk-benefit scale ranging from 0 to 9 by 36 psychiatrist experts in the field of major depression and its treatments. Key-recommendations are provided by the scientific committee after data analysis and interpretation of the results of the survey.ResultsThe scope of these guidelines encompasses the assessment of pharmacological resistance and situations at risk of resistance, as well as the pharmacological and psychological strategies in major depression.ConclusionThe expert consensus guidelines will contribute to facilitate treatment decisions for clinicians involved in the daily assessment and management of treatment-resistant depression across a number of common and complex clinical situations.
Highlights
Clear guidance for successive antidepressant pharmacological treatments for non-responders in major depression is not well established
The expert consensus guidelines will contribute to facilitate treatment decisions for clinicians involved in the daily assessment and management of treatment-resistant depression across a number of common and complex clinical situations
Definition of resistant depression and at-risk situations Based on clinical expert consensus, the definition of treatment-resistant depression adopted is the failure of two ADT of adequate duration and dose
Summary
Clear guidance for successive antidepressant pharmacological treatments for non-responders in major depression is not well established. The availability of novel ADT agents, combined with psychotherapy or brain stimulation techniques, offer a wide array of strategies, but raise questions regarding the selection of the most appropriate therapy for a given patient Several guidelines have already been established by professional societies to assist clinical decision-making at different stages of the treatment They were developed after a critical analysis of scientific data, which were selected and ranked according to their level of evidence, so that data issued from randomised, double-blind, controlled trials (RCT) covering large study samples were considered to provide the highest level of evidence. The French National Health agency recommends the Formal Consensus method when the following conditions are met:
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