Clinical Guidelines of the Egyptian Psychiatric Association for the Management of Treatment-Resistant Unipolar Depression in Egypt.

Tarek Molokheya,Hany Hamed,Victor Samy,Tarek Okasha,Mostafa Shaheen,Momtaz Abdel-Wahab,Mohamed Ali,Abd Elnasser Omar,Menan A Rabie,Mohamed Nasr

doi:10.3389/fpsyt.2022.797150

Abstract

BackgroundMajor depressive disorder (MDD) is a public health burden that creates a strain not only on individuals, but also on the economy. Treatment-resistant depression in the course of major depressive disorder represents a clinically challenging condition that is defined as insufficient response to two or more antidepressant trails with antidepressants of the same or different classes that were administered at adequate daily doses for at least 4 weeks.Objective/HypothesisTo develop a treatment guideline for Treatment Resistant Depression (TRD).MethodologyExperts in the field gathered and reviewed the available evidence about the subject. Then, a series of meetings were held to create recommendations that can be utilized by Egyptian psychiatrists.ResultsThe guidelines provide recommendations in various clinical settings. It evaluates different situations, such as patients at risk of resistance, those with resistance and recommends strategies to resolve the clinical case.ConclusionThe consensus guidelines will improve the outcomes of patients, as they provide recommendations across various domains that are of concern for the practicing psychiatrist.

Highlights

Major depressive disorder (MDD) is defined as a disorder of having one or more major depressive episodes in a person’s life with the absence of manic or hypomanic symptoms; to meet the criteria of MDD five out of nine symptoms, two of which must be low mood and anhedonia persisting for a 2-week period
According to a meta-analysis by Gaynes et al 2019, there is no clear-cut definition for two or more drugs (TRD), most experts unanimously agree that lack of response to initial treatment is deemed as TRD
The APA (American Psychological Association) and NICE (National Institute for Health and Care Excellence) guidelines state that the step of handling TRD differs between experts which makes it more challenging to develop universal treatment guidelines

Summary

Introduction

MDD is defined as a disorder of having one or more major depressive episodes in a person’s life with the absence of manic or hypomanic symptoms; to meet the criteria of MDD five out of nine symptoms, two of which must be low mood and anhedonia (loss of pleasure) persisting for a 2-week period. Major depressive disorder (MDD) is a major public health concern. According to the World Health Organization (WHO), depression affects over 260 million individuals worldwide [3]. Major depressive disorder (MDD) is a public health burden that creates a strain on individuals, and on the economy. Treatment-resistant depression in the course of major depressive disorder represents a clinically challenging condition that is defined as insufficient response to two or more antidepressant trails with antidepressants of the same or different classes that were administered at adequate daily doses for at least 4 weeks

Methods

Results

Discussion

Conclusion