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

doi:10.1016/j.sjpmh.2023.06.001

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

Título traducido de la contribución: Recomendaciones del consenso latinoamericano para el manejo y tratamiento de pacientes con depresión resistente al tratamiento (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

Producción científica: Contribución a revista › Artículo de revisión › revisión exhaustiva

6 Citas (Scopus)

Resumen

A pesar de la abundancia de literatura sobre la depresión resistente al tratamiento (TRD), no existe una definición universalmente aceptada de TRD, y las vías de tratamiento disponibles para el manejo de la TRD varían en la región de América Latina, lo que resalta la necesidad de una definición uniforme y principios de tratamiento para optimizar la gestión de TRD en América Latina.

Métodos
Luego de una revisión de la literatura temática y una encuesta previa a la reunión, un panel de expertos de América Latina compuesto por 14 psiquiatras con experiencia clínica en el manejo de pacientes con TRD se reunió y utilizó el método de idoneidad de RAND/UCLA para desarrollar recomendaciones basadas en consenso sobre la definición apropiada de TRD y sus principios. para su gestión.

Resultados
El panel de expertos estuvo de acuerdo en que la "depresión resistente al tratamiento" (TRD) se define como "el fracaso de dos tratamientos farmacológicos en dosis adecuadas, durante 4 a 8 semanas con una adherencia adecuada, durante un episodio depresivo mayor". Se debe emplear un enfoque de tratamiento gradual para el manejo de la TRD; las estrategias de tratamiento pueden incluir maximizar la dosis, cambiar a una clase diferente y aumentar o combinar tratamientos. Los tratamientos no farmacológicos, como la terapia electroconvulsiva , también son opciones apropiadas para los pacientes con TRD.

Conclusión
Estas recomendaciones de consenso sobre la definición operativa de TRD y los tratamientos aprobados para su manejo pueden adaptarse a los contextos locales de los países latinoamericanos, pero no deben reemplazar el juicio clínico. Se deben considerar cuidadosamente las circunstancias individuales y el equilibrio beneficio-riesgo al determinar la opción de tratamiento más adecuada para los pacientes con TRD.

Título traducido de la contribución	Recomendaciones del consenso latinoamericano para el manejo y tratamiento de pacientes con depresión resistente al tratamiento (TRD)
Idioma original	Inglés estadounidense
Publicación	Spanish Journal of Psychiatry and Mental Health
DOI	https://doi.org/10.1016/j.sjpmh.2023.06.001
Estado	Publicación electrónica previa a su impresión - sep. 22 2023

ODS de las Naciones Unidas

Este resultado contribuye a los siguientes Objetivos de Desarrollo Sostenible

ODS 3: Salud y bienestar

Áreas temáticas de ASJC Scopus

Psiquiatría y salud mental

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Corral, R., Bojórquez, E., Cetkovich-Bakmas, M., Córdoba, R., Chestaro, J., Gama, C., Bonetto, G. G., Jaramillo, C. L., Moreno, R. A., Ng, B., de Leon, E. P., Risco, L., Silva, H., & Vazquez, G. (2023). Latin American consensus recommendations for the management and treatment of patients with treatment-resistant depression (TRD). Spanish Journal of Psychiatry and Mental Health. Avanzar publicación online. https://doi.org/10.1016/j.sjpmh.2023.06.001

@article{b5d3bb97033a4c79b0940a4c040ffdef,

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

abstract = "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 {\textquoteleft}treatment-resistant depression{\textquoteright} (TRD) is defined as {\textquoteleft}failure of two drug treatments of adequate doses, for 4–8 weeks duration with adequate adherence, during a major depressive episode{\textquoteright}. 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.",

author = "Ricardo Corral and Enrique Boj{\'o}rquez and Marcelo Cetkovich-Bakmas and Rodrigo C{\'o}rdoba and Julio Chestaro and Clarissa Gama and Bonetto, \{Gerardo Garc{\'i}a\} and Jaramillo, \{Carlos L{\'o}pez\} and Moreno, \{Ricardo Alberto\} and Bernardo Ng and \{de Leon\}, \{Edilberto Pena\} and Luis Risco and Hern{\'a}n Silva and Gustavo Vazquez",

note = "Publisher Copyright: {\textcopyright} 2023 Sociedad Espa{\~n}ola de Psiquiatr{\'i}a y Salud Mental (SEPSM)",

year = "2023",

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Corral, R, Bojórquez, E, Cetkovich-Bakmas, M, Córdoba, R, Chestaro, J, Gama, C, Bonetto, GG, Jaramillo, CL, Moreno, RA, Ng, B, de Leon, EP, Risco, L, Silva, H & Vazquez, G 2023, 'Latin American consensus recommendations for the management and treatment of patients with treatment-resistant depression (TRD)', Spanish Journal of Psychiatry and Mental Health. https://doi.org/10.1016/j.sjpmh.2023.06.001

TY - JOUR

T1 - Latin American consensus recommendations for the management and treatment of patients with treatment-resistant depression (TRD)

AU - Corral, Ricardo

AU - Bojórquez, Enrique

AU - Cetkovich-Bakmas, Marcelo

AU - Córdoba, Rodrigo

AU - Chestaro, Julio

AU - Gama, Clarissa

AU - Bonetto, Gerardo García

AU - Jaramillo, Carlos López

AU - Moreno, Ricardo Alberto

AU - Ng, Bernardo

AU - de Leon, Edilberto Pena

AU - Risco, Luis

AU - Silva, Hernán

AU - Vazquez, Gustavo

PY - 2023/9/22

Y1 - 2023/9/22

N2 - 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.

AB - 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.

UR - https://www.scopus.com/pages/publications/85188555740

UR - https://www.scopus.com/pages/publications/85188555740#tab=citedBy

U2 - 10.1016/j.sjpmh.2023.06.001

DO - 10.1016/j.sjpmh.2023.06.001

M3 - Review article

C2 - 38592432

AN - SCOPUS:85188555740

JO - Spanish Journal of Psychiatry and Mental Health

JF - Spanish Journal of Psychiatry and Mental Health

ER -

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

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