Treatment-Resistant Depression in Portugal: Perspective From Psychiatry Experts
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...
| Main Authors: | , , , , , , , , |
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| Format: | Article |
| Language: | English |
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Frontiers Media S.A.
2022-03-01
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| Series: | Frontiers in Psychiatry |
| Subjects: | |
| Online Access: | https://www.frontiersin.org/articles/10.3389/fpsyt.2022.824919/full |
| _version_ | 1811272665405587456 |
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| author | João M. Bessa João M. Bessa João M. Bessa Serafim Carvalho Inês B. Cunha Milene Fernandes Ana Matos-Pires Ana Matos-Pires Rui Neves Albino J. Oliveira-Maia Albino J. Oliveira-Maia Susana Santos Vítor Santos |
| author_facet | João M. Bessa João M. Bessa João M. Bessa Serafim Carvalho Inês B. Cunha Milene Fernandes Ana Matos-Pires Ana Matos-Pires Rui Neves Albino J. Oliveira-Maia Albino J. Oliveira-Maia Susana Santos Vítor Santos |
| author_sort | João M. Bessa |
| collection | DOAJ |
| description | 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. |
| first_indexed | 2024-04-12T22:44:24Z |
| format | Article |
| id | doaj.art-0d22cb6dc2534929892cc3445bf04f95 |
| institution | Directory Open Access Journal |
| issn | 1664-0640 |
| language | English |
| last_indexed | 2024-04-12T22:44:24Z |
| publishDate | 2022-03-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Psychiatry |
| spelling | doaj.art-0d22cb6dc2534929892cc3445bf04f952022-12-22T03:13:35ZengFrontiers Media S.A.Frontiers in Psychiatry1664-06402022-03-011310.3389/fpsyt.2022.824919824919Treatment-Resistant Depression in Portugal: Perspective From Psychiatry ExpertsJoão M. Bessa0João M. Bessa1João M. Bessa2Serafim Carvalho3Inês B. Cunha4Milene Fernandes5Ana Matos-Pires6Ana Matos-Pires7Rui Neves8Albino J. Oliveira-Maia9Albino J. Oliveira-Maia10Susana Santos11Vítor Santos12School of Medicine, Life and Health Sciences Research Institute (ICVS), University of Minho, Braga and Guimarães, PortugalICVS/3B's, PT Government Associate Laboratory, Braga and Guimarães, PortugalClinical Academic Center – Braga, Braga, PortugalDepartment of Psychiatry, Hospital de Magalhães Lemos, Porto, PortugalDepartment of Psychiatry, Hospital Júlio de Matos - Psychiatric Hospital Centre of Lisbon, Lisbon, PortugalReal World Evidence and Late Phase, CTI Clinical Trial and Consulting Services, Lisbon, PortugalDepartment of Psychiatry, Unidade Local de Saúde do Baixo Alentejo, Beja, PortugalComprehensive Health Research Center (CHRC), NOVA Medical School - NMS, Universidade Nova de Lisboa, Lisboa, PortugalCasa de Saúde da Idanha, Instituto das Irmãs Hospitaleiras do Sagrado Coração de Jesus, Lisbon, Portugal0Champalimaud Research and Clinical Centre, Champalimaud Foundation, Lisbon, Portugal1NOVA Medical School - NMS, Universidade Nova de Lisboa, Lisbon, Portugal2Janssen-Cilag Farmacêutica Lda, Porto Salvo, Portugal3Department of Psychiatry, Centro Hospitalar e Universitário de Coimbra, Coimbra, PortugalGuidance 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.https://www.frontiersin.org/articles/10.3389/fpsyt.2022.824919/fulltreatment-resistant depressionmajor depressive disorderpatient journeyexpert opinionPortugal |
| spellingShingle | João M. Bessa João M. Bessa João M. Bessa Serafim Carvalho Inês B. Cunha Milene Fernandes Ana Matos-Pires Ana Matos-Pires Rui Neves Albino J. Oliveira-Maia Albino J. Oliveira-Maia Susana Santos Vítor Santos Treatment-Resistant Depression in Portugal: Perspective From Psychiatry Experts Frontiers in Psychiatry treatment-resistant depression major depressive disorder patient journey expert opinion Portugal |
| title | Treatment-Resistant Depression in Portugal: Perspective From Psychiatry Experts |
| title_full | Treatment-Resistant Depression in Portugal: Perspective From Psychiatry Experts |
| title_fullStr | Treatment-Resistant Depression in Portugal: Perspective From Psychiatry Experts |
| title_full_unstemmed | Treatment-Resistant Depression in Portugal: Perspective From Psychiatry Experts |
| title_short | Treatment-Resistant Depression in Portugal: Perspective From Psychiatry Experts |
| title_sort | treatment resistant depression in portugal perspective from psychiatry experts |
| topic | treatment-resistant depression major depressive disorder patient journey expert opinion Portugal |
| url | https://www.frontiersin.org/articles/10.3389/fpsyt.2022.824919/full |
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