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

Summary & key facts

The authors looked at randomized trials that called people "treatment resistant" or "refractory" for major depression. They found that different trials used very different rules for what counts as treatment resistant, and many trials did not describe past treatments clearly. Because of this mix-up, it is hard to compare trial results or know which treatments actually help people who have not improved with earlier care.

Key facts:

• The paper reviewed randomized trials that enrolled people described as having treatment resistant or refractory major depression.
• Trials used different and inconsistent rules for how many previous treatments had failed before someone was called treatment resistant. Some studies required only one failed treatment while others required more.
• Many trials did not give enough detail about the previous treatments people had tried, such as doses or how long they were taken.
• Because definitions and reporting varied so much, it is difficult to compare results across studies or to tell which treatments work best for people who have not responded to earlier care.
• The authors conclude that researchers need a clear, shared definition and better reporting about past treatments so future trials can be compared and so results are more useful for patients and doctors.

Topics

Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes Mental Health Treatment and Access 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