Latin American consensus recommendations for the management and treatment of patients with treatment-resistant depression (TRD)

Ricardo Corral, Enrique Bojórquez, Marcelo Cetkovich-Bakmas, Rodrigo Córdoba, Julio Chestaro, Clarissa Gama, Gerardo García Bonetto, Carlos López Jaramillo, Ricardo Alberto Moreno, Bernardo Ng, Edilberto Pena de Leon, Luis Risco, Hernán Silva, Gustavo Vazquez

Research output: Contribution to journalReview articlepeer-review

1 Scopus citations


Despite the abundance of literature on treatment-resistant depression (TRD), there is no universally accepted definition of TRD, and available treatment pathways for the management of TRD vary across the Latin American region, highlighting the need for a uniform definition and treatment principles to optimize the management of TRD in Latin America.

Methods: Following a thematic literature review and pre-meeting survey, a Latin America expert panel comprising 14 psychiatrists with clinical experience in managing patients with TRD convened and utilized the RAND/UCLA appropriateness method to develop consensus-based recommendations on the appropriate definition of TRD and principles for its management.

Results: The expert panel agreed that ‘treatment-resistant depression’ (TRD) is defined as ‘failure of two drug treatments of adequate doses, for 4–8 weeks duration with adequate adherence, during a major depressive episode’. A stepwise treatment approach should be employed for the management of TRD – treatment strategies can include maximizing dose, switching to a different class, and augmenting or combining treatments. Nonpharmacological treatments, such as electroconvulsive therapy, are also appropriate options for patients with TRD.

Conclusion: These consensus recommendations on the operational definition of TRD and approved treatments for its management can be adapted to local contexts in the Latin American countries but should not replace clinical judgement. Individual circumstances and benefit–risk balance should be carefully considered while determining the most appropriate treatment option for patients with TRD.

Translated title of the contributionRecomendaciones del consenso latinoamericano para el manejo y tratamiento de pacientes con depresión resistente al tratamiento (TRD)
Original languageEnglish (US)
JournalSpanish Journal of Psychiatry and Mental Health
StateE-pub ahead of print - Sep 22 2023

All Science Journal Classification (ASJC) codes

  • Psychiatry and Mental health


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