Treatment resistant depression: A systematic review of treatments

• Alia Inés Pérez-Wehbe ^[2] ; Lilisbeth Perestelo-Pérez ^[3] ; Amado Rivero-Santana ^[4] ; Juan Manuel Bethencourt Pérez ^[1] ; Leticia Cuellar-Pompa ^[4] ; Wenceslao Peñate Castro ^[1]
  1. [1] Universidad de La Laguna

     Universidad de La Laguna

     San Cristóbal de La Laguna, España

     
  2. [2] Grupo Sanitario ICOT. Centro Sociosanitario El Pino, Gran Canaria, Spain
  3. [3] Servicio de Evaluación del Servicio Canario de la Salud – Red de Investigación en Servicios Sanitarios en Enfermedades Crónicas (REDISSEC). Tenerife, Spain
  4. [4] Fundación Canaria de Investigación y Salud (FUNCIS). Tenerife, Spain

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• Localización: Avances en psicología clínica. 2013: Libro de capítulos del VI Congreso Internacional y XI Nacional de Psicología Clínica / coord. por Raúl Quevedo Blasco, Víctor José Quevedo Blasco, 2013, ISBN 978-84-695-6987-0, págs. 95-100
• Idioma: inglés
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• Resumen

  • The aim of this systematic review (SR) is to know the current status of treatments for treatmentresistant depression (TRD). Following The Cochrane Collaboration’s criteria a SR wasconducted for randomised controlled trials (RCT) published until September 2012, in sixelectronic databases. The quality of selected papers was assessed according to Jadad Scale.Remission of symptoms, treatment response and changes in depression severity levels weretaken as criteria for effectiveness. After eliminating duplicates, a total of 13,367 references wereidentified of which 247 were selected for full-text reading. Finally, 23 studies plus one studyfrom the manual search were included. The discussion includes a diversity of currently existingdefinitions for TRD, the heterogeneity of parameters or variables used and factors considered inTRD treatments and the methodological variability found in these studies. Although withmodest results, there are numerous pharmacological treatments and brain stimulation techniquesshowing efficacy for TRD (with an almost nonexistent representation of psychologicaltreatments). The possibility of establishing general conclusions is limited due to the scarcity ofcomparative studies between those treatments types and the range of parameters andmethodology used by the included studies. However, added to the need for further research witha more robust methodology and consensus, it is concluded, based on the available informationand following the proposal of the National Institute for Clinical Excellence (NICE), the need tounderstand TRD from a dimensional perspective (and not categorical as to the present) thatincludes a stepped care model with a multidisciplinary approach which takes into account,among others, the psychosocial factors involved and the individuality of each patient, at thetime of considering available treatments.