Treatment-resistant and multi-therapy criteria for bipolar depression: A consensus definition
AuthorMorriss, Richard K.
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AbstractIntroduction: Most people with bipolar disorder (BD) spend a significant percentage of their life experiencing either sub-syndromal depressive symptoms or major depressive episodes, which contribute greatly to the high levels of disability and mortality associated with BD. Despite the importance of bipolar depression, there are only a small number of treatment options available. Consecutive treatment failures can quickly exhaust these options leading to treatment-resistant bipolar depression (TRBD). Few studies have evaluated TRBD and those available lack a comprehensive definition of multi-therapy resistant bipolar depression (MTRBD). The aim of this study was to reach consensus regarding threshold definitions criterion for TRBD and MTRBD.
Method(s): Based on the evidence of standard treatments available in the latest BD treatment guidelines, TRBD and MTRBD criteria were agreed by a representative panel of BD experts using a modified Delphi method.
Result(s): TRBD criteria in bipolar depression was defined as failure to reach sustained remission for 8 consecutive weeks after two different treatment trials, at adequate therapeutic doses, with at least two recommended monotherapy treatments or at least one monotherapy treatment and another combination treatment. MTRBD included the same definition as TRBD, with the addition of failure of at least one antidepressant trial, a psychological treatment and a course of electroconvulsive therapy.
Conclusion(s): The proposed TRBD and MTRBD criteria may provide an important signpost to help clinicians and researchers in judging when to consider new non-standard treatments. However, some challenging diagnostic and therapeutic issues were identified in the consensus process which need further evaluation and research.