Multiple-therapy-resistant major depressive disorder: a clinically important concept
Open accessAbstract
Summary: Many novel therapeutic options for depression exist that are either not mentioned in clinical guidelines or recommended only for use in highly specialist services. The challenge faced by clinicians is when it might be appropriate to consider such ‘non-standard’ interventions. This analysis proposes a framework to aid this decision. Declaration of interest: In the past 3 years R.H.M.W. has received support for research, expenses to attend conferences and fees for lecturing and consultancy work (including attending advisory boards) from various pharmaceutical companies including Astra Zeneca, Cyberonics, Eli Lilly, Janssen, LivaNova, Lundbeck, MyTomorrows, Otsuka, Pfizer, Roche, Servier, SPIMACO and Sunovion. D.M.B.C. has received fees from LivaNova for attending an advisory board. In the past 3 years A.J.C. has received fees for lecturing from Astra Zeneca and Lundbeck; fees for consulting from LivaNova, Janssen and Allergan; and research grant support from Lundbeck. In the past 3 years A.C. has received fees for lecturing from pharmaceutical companies namely Lundbeck and Sunovion. In the past 3 years A.L.M. has received support for attending seminars and fees for consultancy work (including advisory board) from Medtronic Inc and LivaNova. R.M. holds joint research grants with a number of digital companies that investigate devices for depression including Alpha-stim, Big White Wall, P1vital, Intel, Johnson and Johnson and Lundbeck through his mindTech and CLAHRC EM roles. M.S. is an associate at Blueriver Consulting providing intelligence to NHS organisations, pharmaceutical and devices companies. He has received honoraria for presentations and advisory boards with Lundbeck, Eli Lilly, URGO, AstraZeneca, Phillips and Sanofi and holds shares in Johnson and Johnson. In the past 3 years P.R.A.S. has received support for research, expenses to attend conferences and fees for lecturing and consultancy work (including attending an advisory board) from life sciences companies including Corcept Therapeutics, Indivior and LivaNova. In the past 3 years P.S.T. has received consultancy fees as an advisory board member from the following companies: Galen Limited, Sunovion Pharmaceuticals Europe Ltd, myTomorrows and LivaNova. A.H.Y. has undertaken paid lectures and advisory boards for all major pharmaceutical companies with drugs used in affective and related disorders and LivaNova. He has received funding for investigator initiated studies from AstraZeneca, Eli Lilly, Lundbeck and Wyeth.
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None of the extant TRD definitions are universally accepted and/or implemented at point-of-care in clinical practice.
“None of the extant TRD definitions are universally accepted and/or implemented at point- of- care in clinical practice 11,32,64- 68 .”
From Treatment‐resistant depression: definition, prevalence, detection, management, and investigational interventions (2023) · cites this paper as [67]
In “Problems and possible solutions” (page unavailable), the paper says studies vary in how they define treatment resistance and proposes a new reference point, supporting the lack of a single accepted definition. It does not establish whether existing definitions are implemented at the point of care in clinical practice. (LLM, conf=0.82)
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“…incomplete response is not binary, but rather a continuum that ranges from partially responsive depression (PRD) to treatment-resistant depression (TRD) to multi-therapy resistant MDD (MTR-MDD) to refractory depression, which denotes no response to any of the currently recommended treatments [22].”
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Når depresjon blir behandlingsresistent
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- Authors
- McAllister-Williams, R. H., Christmas, D. M. B., Cleare, A. J., Currie, A., Gledhill, J., Insole, L., Malizia, A. L., McGeever, M., Morriss, R., Robinson, L. J., Scott, M., Stokes, P. R. A., Talbot, P. S., & Young, A. H.
- Affiliations
- Ninewells Hospital (GB)
- King's College London (GB)
- Cumbria Northumberland Tyne and Wear NHS Foundation Trust (GB)
- North Bristol NHS Trust (GB)
- NHS Newcastle Gateshead Clinical Commissioning Group (GB)
- University of Nottingham (GB)
- Greater Manchester Mental Health NHS Foundation Trust (GB)
- ORCID
- Venue
- British Journal of Psychiatry
- Publisher
- Royal College of Psychiatrists
- Published
- 2018-02-13
- Volume
- 212
- Issue
- 5
- Pages
- 274-278
- ISSN
- 0007-1250 (ISSN-L)
- 1472-1465
- OpenAlex
- W2753744831
- Cited by
- 40
- References
- 20
- Citations by year
- 2026: 2 · 2025: 2 · 2024: 7 · 2023: 2 · 2022: 4 · 2021: 8 · 2020: 6 · 2019: 3 · 2018: 6
- FWCI
- 3.71
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- The British Journal of Psychiatry (publishedVersion)
- PubMed (publishedVersion)
- Research Explorer (The University of Manchester) (publishedVersion, other-oa)
- Discovery Research Portal (University of Dundee) (submittedVersion, other-oa)
- Research Portal (King's College London) (submittedVersion, other-oa)
- Nottingham ePrints (University of Nottingham) (submittedVersion, cc-by)
- Repository@Nottingham (University of Nottingham) (submittedVersion, cc-by)
- Newcastle University ePrints (Newcastle Univesity)
- Funders
- Eli Lilly and Company
- AstraZeneca
- Sanofi
- South London and Maudsley NHS Foundation Trust
- Sunovion
- Indivior
- LivaNova
- National Institute for Health and Care Research (NF-SI-0616-10091, NF-SI-0617-10016)
- King's College London
- University of Nottingham
- Newcastle upon Tyne Hospitals NHS Foundation Trust
- H. Lundbeck A/S (P1vital)
- Allergan
- Topics
- Health Sciences › Medicine › Pharmacology › Treatment of Major Depression
- Health Sciences › Medicine › Psychiatry and Mental health › Electroconvulsive Therapy Studies
- Health Sciences › Medicine › Neurology › Neurological disorders and treatments
- Keywords
- major depressive disorder, treatment-resistant depression, newer antidepressants, digital therapeutics, transcranial magnetic stimulation, esketamine, ketamine, antidepressant augmentation, pharmaceutical industry conflicts of interest
- MeSH terms
- Major Depressive Disorder, Humans, Depressive Disorder, Treatment-Resistant
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