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Treatment-Resistant Depression in Portugal
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Orientador(es)
Resumo(s)
Guidance about treatment-resistant depression (TRD) in Portugal is very limited, even though depression prevalence is among the highest in European countries. A questionnaire was conducted, followed by two advisory boards with seven Portuguese psychiatry experts, to characterize and discuss MDD and TRD epidemiology, diagnosis, patient journey, treatment options, and unmet clinical needs. Consensus was reached on the main issues. In daily practice, TRD can be defined as moderate to severe MDD episodes with insufficient clinical improvement after two antidepressant treatments, taken in adequate doses and duration. TRD diagnosis and treatment are mostly decided by psychiatrists at public hospitals. Treatment type and duration must be adjusted to characteristics of the patient and the depressive episode, including symptoms, number of previous episodes, comorbidities, and previous treatment response and side effects. The most relevant objectives of TRD treatment are reaching response and remission, prevention of suicide, and improvement of quality of life, functionality, and wellbeing. Regarding pharmacotherapy, antidepressant switch occurs more frequently with non-response, while optimization, combination, and augmentation are considered for patients with partial response. Psychotherapy should be considered in parallel to pharmacological treatment. Brain stimulation techniques are underused. Lifelong treatment is required for recurrent or more chronic TRD episodes, but patient adherence is also poorer in these cases. In Portugal, TRD management is limited by lack of access to specialist care and to many treatment options. These aspects highlight that conventional pharmacotherapy does not lead to remission in many patients and that optimization strategies are frequently necessary to achieve satisfactory treatment outcomes.
Descrição
Funding Information: SS is an employee of Janssen-Cilag Farmacêutica Lda. MF is an employee of CTI Clinical Trial and Consulting Services. The remaining authors received advisory board fees from Janssen-Cilag Farmacêutica Lda. AO-M was the national coordinator for Portugal of a non-interventional study EDMS-ERI-143085581, 4.0 to characterize a Treatment-Resistant Depression Cohort in Europe, sponsored by Janssen-Cilag, Ltd. 2019–2020; is the recipient of a grant from Schuhfried GmBH for norming and validation of cognitive tests; and is the national coordinator for Portugal of trials of psilocybin therapy for treatment-resistant depression, sponsored by Compass Pathways, Ltd. EudraCT numbers 2017-003288-36 and 2020-001348-25, and of esketamine for treatment-resistant depression, sponsored by Janssen-Cilag, Ltd. EudraCT Number: 2019-002992-33. Janssen had no influence on the interpretation of results. This manuscript presents the opinion of the psychiatry experts only. Funding Information: Support for third-party advisory board logistics and writing assistance, provided by CTI Clinical Trial and Consulting Services, was funded by Janssen-Cilag Farmacêutica Lda in accordance with Good Publication Practice (GPP3) guidelines. Publisher Copyright: Copyright © 2022 Bessa, Carvalho, Cunha, Fernandes, Matos-Pires, Neves, Oliveira-Maia, Santos and Santos.
Palavras-chave
expert opinion major depressive disorder patient journey Portugal treatment-resistant depression Psychiatry and Mental health SDG 3 - Good Health and Well-being