What is the meaning of treatment resistant/refractory major depression (TRD)? A systematic review of current randomized trials

Summary & key facts

Researchers reviewed randomized trials that studied ‘treatment-resistant’ or ‘treatment-refractory’ major depression to see what those labels actually meant. They found that different studies used very different rules for calling depression “treatment resistant,” so people enrolled in one trial could be quite different from people in another. The authors said this makes it hard to compare study results and to know which treatments really help people with hard-to-treat depression, and they urged researchers to agree on clear, step-by-step definitions.

Key facts:

• The paper looked across randomized trials that used the terms “treatment-resistant” or “treatment-refractory” for major depression and checked how each study defined those terms.
• Different trials used different thresholds: some counted failure of one adequate antidepressant as resistance, while others required failure of two or more treatments before calling a case treatment-resistant.
• Because studies used inconsistent definitions, it becomes difficult to compare results from one trial to another or to know which treatments work for people with truly hard-to-treat depression.
• The authors recommended using clear, shared definitions and a staging system that records how many adequate treatments a person has tried, so future trials are easier to compare.
• For people, this means that being labeled “treatment-resistant” in one study might not match the same label in another study, so research findings do not always translate directly into what will help any one person.

Topics

Electroconvulsive Therapy Studies Functional Brain Connectivity Studies Treatment of Major Depression

Categories

Health Sciences Medicine Pharmacology

Tags

Cochrane Library Cognition Depression (economics) Economics Internal medicine Law Macroeconomics Major depressive disorder Medicine MEDLINE Pediatrics Political science Psychiatry PsycINFO Randomized controlled trial Systematic review Treatment-resistant depression

Conditions & symptoms

Depression Lack of energy or motivation Poor sleep Sadness or low mood