Is it Time for a ‘Reconceptualization’ of TRD? Some Think Yes
Treatment-resistant depression (TRD) may be a more complex and multifaceted condition than previously thought, with authors of a recent study calling for a “unified definition and reconceptualization” of the illness. Their findings were published in the Journal of Affective Disorders.
“Our study highlights a population grappling with a debilitating condition that is critically underserved in terms of therapeutic provision,” noted lead author Felicitas Rost, PhD, The Open University, School of Psychology and Psychotherapy, Milton Keynes, UK, and co-authors.” An emerging consensus suggests that without a unified definition of TRD, research progression may stall. Definitional endeavors should be data-informed, veering away from potentially biased consensus-based delineations influenced by healthcare structures and clinical notions.”
Related: Review Finds Little Consensus on Treatment-Resistant Depression in Real World
The pragmatic randomized controlled trial analyzed 129 primary care patients diagnosed with TRD. Data included previous treatment attempts, illness characteristics, functioning, quality of life, co-occurring problems including suicidality, psychiatric and personality disorders, physical health conditions, and adverse events.
Key findings from the study emphasize that TRD is a chronic and severe condition, with an average illness duration exceeding 25 years. Most patients exhibited significant psychiatric and physical health comorbidities. Notably, 82.9% had at least 1 additional psychiatric diagnosis, and 82.2% met criteria for at least 1 personality disorder. Physical health conditions were prevalent, with nearly 70% reporting musculoskeletal, gastrointestinal, genitourinary, cardiovascular, or respiratory problems. Nearly all participants experienced severe social and occupational dysfunction, and quality-of-life measures were markedly low. Suicidality was common, with 44.9% reported at least 1 serious suicide attempt and 17.8% reporting an attempt during childhood or adolescence. Furthermore, 79.8% of patients reported at least 1 adverse childhood experience, highlighting the role of early life trauma in TRD.
Authors noted that the study’s cross-sectional design and reliance on self-reported data may have introduced potential recall bias. Another possible study limitation was the lack of a control group and possible interactions among variables not being closely examined.
“We urge researchers and clinicians to present comprehensive profiles of their cohorts, spanning both trial settings and real-world contexts,” Dr Rost and co-authors concluded. “This can foster a richer understanding of TRD, propelling research aimed at identifying enhanced treatment strategies.”
