Treatment-Resistant Depression in Portugal: Perspective From Psychiatry Experts

João M Bessa; Serafim Carvalho; Inês B Cunha; Milene Fernandes; Ana Matos-Pires; Rui Neves; Albino J Oliveira-Maia; Susana Santos; Vítor Santos

doi:10.3389/fpsyt.2022.824919

Treatment-Resistant Depression in Portugal: Perspective From Psychiatry Experts

Front Psychiatry. 2022 Mar 30:13:824919. doi: 10.3389/fpsyt.2022.824919. eCollection 2022.

Authors

João M Bessa^{1

2

3}, Serafim Carvalho⁴, Inês B Cunha⁵, Milene Fernandes⁶, Ana Matos-Pires^{7

8}, Rui Neves⁹, Albino J Oliveira-Maia^{10

11}, Susana Santos¹², Vítor Santos¹³

Affiliations

¹ School of Medicine, Life and Health Sciences Research Institute (ICVS), University of Minho, Braga and Guimarães, Portugal.
² ICVS/3B's, PT Government Associate Laboratory, Braga and Guimarães, Portugal.
³ Clinical Academic Center - Braga, Braga, Portugal.
⁴ Department of Psychiatry, Hospital de Magalhães Lemos, Porto, Portugal.
⁵ Department of Psychiatry, Hospital Júlio de Matos - Psychiatric Hospital Centre of Lisbon, Lisbon, Portugal.
⁶ Real World Evidence and Late Phase, CTI Clinical Trial and Consulting Services, Lisbon, Portugal.
⁷ Department of Psychiatry, Unidade Local de Saúde do Baixo Alentejo, Beja, Portugal.
⁸ Comprehensive Health Research Center (CHRC), NOVA Medical School - NMS, Universidade Nova de Lisboa, Lisboa, Portugal.
⁹ Casa de Saúde da Idanha, Instituto das Irmãs Hospitaleiras do Sagrado Coração de Jesus, Lisbon, Portugal.
¹⁰ Champalimaud Research and Clinical Centre, Champalimaud Foundation, Lisbon, Portugal.
¹¹ NOVA Medical School - NMS, Universidade Nova de Lisboa, Lisbon, Portugal.
¹² Janssen-Cilag Farmacêutica Lda, Porto Salvo, Portugal.
¹³ Department of Psychiatry, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal.

Abstract

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.

Keywords: Portugal; expert opinion; major depressive disorder; patient journey; treatment-resistant depression.