Prevalence of treatment-resistant depression in primary care: cross-sectional data
Open accessAbstract
BACKGROUND: Antidepressants are often the first-line treatment for depression in primary care. However, not all patients respond to medication after an adequate dose and duration of treatment. Currently, there are no estimates of the prevalence of treatment-resistant depression (TRD) from UK primary care. AIM: To estimate the prevalence of TRD in UK primary care. Design and setting Data were collected as part of a multicentre randomised controlled trial, from 73 general practices in UK primary care. METHOD: Potential participants (aged 18-75 years who had received repeated prescriptions for antidepressants) were identified from general practice records. Those who agreed to be contacted were mailed a questionnaire that included questions on depressive symptoms (Beck Depression Inventory [BDI-II]), and adherence to antidepressants. Those who scored ≥14 on the BDI-II and had taken antidepressants for at least 6 weeks at an adequate dose were defined as treatment resistant. RESULTS: A total of 2439 patients completed the questionnaire (84% of those who agreed to be contacted), of whom 2129 had been prescribed an adequate dose of antidepressants for at least 6 weeks. Seventy-seven per cent (95% CI = 75% to 79%) had a BDI score of ≥14. Fifty-five per cent (95% CI = 53% to 58%) (n = 1177) met the study's definition of TRD, of whom 67% had taken their antidepressants for more than 12 months. CONCLUSION: The high prevalence of TRD is an important challenge facing clinicians in UK primary care. A more proactive approach to managing this patient population is required to improve outcome.
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It is currently estimated that at least 30% of persons with depression meet the FDA/EMA definition of TRD.
“It is currently estimated that at least 30% of persons with depression meet this definition.”
From Treatment‐resistant depression: definition, prevalence, detection, management, and investigational interventions (2023) · cites this paper as [99]
The Results and Prevalence sections report that 55% of sampled UK primary-care patients prescribed antidepressants met the study’s definition of TRD, a figure above 30%. But the Defining treatment resistance section uses persistent symptoms after at least six weeks on an adequate antidepressant dose; the paper does not establish that at least 30% of all persons with depression meet the FDA/EMA definition. Page numbers are unavailable in our copy. (LLM, conf=0.85)
Experimental — accuracy not yet measuredTRD is often stated to affect approximately 30% of persons receiving antidepressant treatment in research settings, while its prevalence in real world practice is estimated to range between 6 and 55%.
“TRD is often stated to af fect approximately 30% of persons receiving antidepressant treatment in research set tings, while its prevalence in real world prac- tice is estimated to range between 6 and 55% 32,98- 101 .”
From Treatment‐resistant depression: definition, prevalence, detection, management, and investigational interventions (2023) · cites this paper as [99]
The Introduction reports that 33% of STAR*D participants did not achieve remission after four treatment courses, and the discussion cites prior TRD prevalence estimates of 30–50%. The Results report 55% under this study’s definition in UK primary care. Our copy does not support 6% as the lower end of a real-world prevalence range; its 55% estimate is specific to the patients and definition studied. (LLM, conf=0.88)
Experimental — accuracy not yet measuredDifferences in the definition of TRD have resulted in highly variable estimates of its prevalence rate.
“Differences in the definition of TRD have resulted in highly variable estimates of its prevalence rate 99 .”
From Treatment‐resistant depression: definition, prevalence, detection, management, and investigational interventions (2023) · cites this paper as [99]
Approximately only one in two patients with major depressive disorder respond to their antidepressant treatment.
“Approximately only one in two patients with major depressive disorder (MDD) respond to their antidepressant treatment ( Rush et al., 2006 , Souery et al., 2007 , Thomas et al., 2013 )”
From Self-blame-selective hyper-connectivity between anterior temporal and subgenual cortices predicts prognosis in major depressive disorder (2023) · cites this paper as Thomas et al., 2013
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“Approximately only one in two patients with major depressive disorder (MDD) respond to their antidepressant treatment (Rush et al., 2006; Souery et al., 2007; Thomas et al., 2013), while more than a third fail to achieve remission even after several rounds of treatment (Al-Harbi, 2012; Gaynes et al.”
Background
- Authors
- Thomas, L., Kessler, D., Campbell, J., Morrison, J., Peters, T. J., Williams, C., Lewis, G., & Wiles, N.
- Affiliations
- University of Bristol (GB)
- University of Exeter (GB)
- University of Glasgow (GB)
- University College London (GB)
- Venue
- British Journal of General Practice
- Published
- 2013-12
- Volume
- 63
- Issue
- 617
- Pages
- e852-e858
- ISSN
- 0960-1643 (ISSN-L)
- 1478-5242
- PMC
- PMC3839394
- OpenAlex
- W2136228108
- Cited by
- 175
- References
- 20
- Citations by year
- 2026: 10 · 2025: 17 · 2024: 18 · 2023: 22 · 2022: 13 · 2021: 34 · 2020: 14 · 2019: 10 · 2018: 11 · 2017: 9 · 2016: 7 · 2015: 7 · 2014: 3
- FWCI
- 4.16
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- British Journal of General Practice (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- UCL Discovery (University College London) (submittedVersion)
- Explore Bristol Research (submittedVersion)
- Bristol Research (University of Bristol) (submittedVersion)
- Funders
- National Institute for Health and Care Research (NF-SI-0512-10026, 06/404/501, 06/404/02)
- Scottish Mental Health Research Network
- Topics
- Health Sciences › Medicine › Pharmacology › Treatment of Major Depression
- Social Sciences › Psychology › Social Psychology › Mental Health Treatment and Access
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
- Keywords
- treatment-resistant depression, prevalence, antidepressants, primary care, antidepressant adherence, Beck Depression Inventory, depressive symptoms, general practice, drug response
- MeSH terms
- Adolescent, Adult, Aged, Antidepressive Agents, Combined Modality Therapy, Cross-Sectional Studies, Depressive Disorder, Drug Resistance, Female, United Kingdom, Humans, Male, Middle Aged, Cognitive Behavioral Therapy, Young Adult
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