Treatment of difficult-to-treat depression - clinical guideline for selected interventions
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Treatment of difficult-to-treat depression - clinical guideline for selected interventions. / Møller, Stine Bjerrum; Gbyl, Krzysztof; Hjorthøj, Carsten; Andreasen, Maike; Austin, Stephen F; Buchholtz, Poul Erik; Fønss, Line; Hjerrild, Simon; Hogervorst, Lise; Jørgensen, Martin Balslev; Ladegaard, Nicolai; Martiny, Klaus; Meile, Jonas; Packness, Aake; Sigaard, Karen Rodriguez; Straarup, Krista; Straszek, Sune P V; Soerensen, Claus Havregaard; Welcher, Birgitte; Videbech, Poul.
I: Nordic Journal of Psychiatry, Bind 76, Nr. 3, 2022, s. 177-188.Publikation: Bidrag til tidsskrift › Tidsskriftartikel › Forskning › fagfællebedømt
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TY - JOUR
T1 - Treatment of difficult-to-treat depression - clinical guideline for selected interventions
AU - Møller, Stine Bjerrum
AU - Gbyl, Krzysztof
AU - Hjorthøj, Carsten
AU - Andreasen, Maike
AU - Austin, Stephen F
AU - Buchholtz, Poul Erik
AU - Fønss, Line
AU - Hjerrild, Simon
AU - Hogervorst, Lise
AU - Jørgensen, Martin Balslev
AU - Ladegaard, Nicolai
AU - Martiny, Klaus
AU - Meile, Jonas
AU - Packness, Aake
AU - Sigaard, Karen Rodriguez
AU - Straarup, Krista
AU - Straszek, Sune P V
AU - Soerensen, Claus Havregaard
AU - Welcher, Birgitte
AU - Videbech, Poul
PY - 2022
Y1 - 2022
N2 - BACKGROUND: Difficult-to-treat-depression (DTD) is a clinical challenge. The interventions that are well-established for DTD are not suitable or effective for all the patients. Therefore, more treatment options are highly warranted. We formulated an evidence-based guideline concerning six interventions not well-established for DTD in Denmark.METHODS: Selected review questions were formulated according to the PICO principle with specific definitions of the patient population (P), the intervention (I), the comparison (C), and the outcomes of interest (O), and systematic literature searches were performed stepwise for each review question to identify relevant systematic reviews/meta-analyses, and randomized controlled trials. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) system was used to assess the methodological quality of the included studies. Clinical recommendations were formulated based on the evidence, the risk-benefit ratio, and perceived patient preferences.RESULTS: We found sufficient evidence for a weak recommendation of repetitive transcranial magnetic stimulation (rTMS) and cognitive behavioural analysis system of psychotherapy (CBASP). The use of bright light therapy in DTD was not sufficiently supported by the evidence, but should be considered as good clinical practice. The interventions should be considered in addition to ongoing antidepressant treatment. We did not find sufficient evidence to recommend intravenous ketamine/esketamine, rumination-focused psychotherapy, or cognitive remediation to patients with DTD.CONCLUSION: The evidence supported two of the six reviewed interventions, however it was generally weak which emphasizes the need for more good quality studies. This guideline does not cover all treatment options and should be regarded as a supplement to relevant DTD-guidelines.
AB - BACKGROUND: Difficult-to-treat-depression (DTD) is a clinical challenge. The interventions that are well-established for DTD are not suitable or effective for all the patients. Therefore, more treatment options are highly warranted. We formulated an evidence-based guideline concerning six interventions not well-established for DTD in Denmark.METHODS: Selected review questions were formulated according to the PICO principle with specific definitions of the patient population (P), the intervention (I), the comparison (C), and the outcomes of interest (O), and systematic literature searches were performed stepwise for each review question to identify relevant systematic reviews/meta-analyses, and randomized controlled trials. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) system was used to assess the methodological quality of the included studies. Clinical recommendations were formulated based on the evidence, the risk-benefit ratio, and perceived patient preferences.RESULTS: We found sufficient evidence for a weak recommendation of repetitive transcranial magnetic stimulation (rTMS) and cognitive behavioural analysis system of psychotherapy (CBASP). The use of bright light therapy in DTD was not sufficiently supported by the evidence, but should be considered as good clinical practice. The interventions should be considered in addition to ongoing antidepressant treatment. We did not find sufficient evidence to recommend intravenous ketamine/esketamine, rumination-focused psychotherapy, or cognitive remediation to patients with DTD.CONCLUSION: The evidence supported two of the six reviewed interventions, however it was generally weak which emphasizes the need for more good quality studies. This guideline does not cover all treatment options and should be regarded as a supplement to relevant DTD-guidelines.
U2 - 10.1080/08039488.2021.1952303
DO - 10.1080/08039488.2021.1952303
M3 - Journal article
C2 - 34455900
VL - 76
SP - 177
EP - 188
JO - Nordisk Psykiatrisk Tidsskrift
JF - Nordisk Psykiatrisk Tidsskrift
SN - 0803-9496
IS - 3
ER -
ID: 279133652