Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2022 Mar 30:13:824919.
doi: 10.3389/fpsyt.2022.824919. eCollection 2022.

Treatment-Resistant Depression in Portugal: Perspective From Psychiatry Experts

João M Bessa  1   2   3 , Serafim Carvalho  4 , Inês B Cunha  5 , Milene Fernandes  6 , Ana Matos-Pires  7   8 , Rui Neves  9 , Albino J Oliveira-Maia  10   11 , Susana Santos  12 , Vítor Santos  13
Affiliations

Treatment-Resistant Depression in Portugal: Perspective From Psychiatry Experts

João M Bessa et al. Front Psychiatry. .

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.

PubMed Disclaimer

Conflict of interest statement

SS is an employee of Janssen-Cilag Farmacêutica Lda. MF is an employee of CTI Clinical Trial and Consulting Services. The remaining authors received advisory board fees from Janssen-Cilag Farmacêutica Lda. AO-M was the national coordinator for Portugal of a non-interventional study EDMS-ERI-143085581, 4.0 to characterize a Treatment-Resistant Depression Cohort in Europe, sponsored by Janssen-Cilag, Ltd. 2019–2020; is the recipient of a grant from Schuhfried GmBH for norming and validation of cognitive tests; and is the national coordinator for Portugal of trials of psilocybin therapy for treatment-resistant depression, sponsored by Compass Pathways, Ltd. EudraCT numbers 2017-003288-36 and 2020-001348-25, and of esketamine for treatment-resistant depression, sponsored by Janssen-Cilag, Ltd. EudraCT Number: 2019-002992-33. Janssen had no influence on the interpretation of results. This manuscript presents the opinion of the psychiatry experts only.

Figures

Figure 1
Figure 1
TRD diagnosis and treatment decision (A) and follow-up after recovery (B).
Figure 2
Figure 2
Rates of response and remission (A) and duration of remission after successful treatment (B).
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

References

    1. World Health Organization . Depression and Other Common Mental Disorders: Global Health Estimates. Geneva: World Health Organization; (2017).
    1. Thornicroft G, Chatterji S, Evans-Lacko S, Gruber M, Sampson N, Aguilar-Gaxiola S, et al. . Undertreatment of people with major depressive disorder in 21 countries. Br J Psychiatry. (2017) 210:119–24. 10.1192/bjp.bp.116.188078 - DOI - PMC - PubMed
    1. Arias-de la Torre J, Vilagut G, Ronaldson A, Serrano-Blanco A, Martin V, Peters M, et al. . Prevalence and variability of current depressive disorder in 27 European countries: a population-based study. Lancet Public Health. (2021) 6:e729–38. 10.1016/S2468-2667(21)00047-5 - DOI - PMC - PubMed
    1. Antunes A, Frasquilho D, Azeredo-Lopes S, Neto D, Silva M, Cardoso G, et al. . Disability and common mental disorders: results from the World Mental Health Survey Initiative Portugal. Eur Psychiatry. (2018) 49:56–61. 10.1016/j.eurpsy.2017.12.004 - DOI - PubMed
    1. Malhi GS, Mann JJ. Depression. Lancet. (2018) 392:2299–312. 10.1016/S0140-6736(18)31948-2 - DOI - PubMed

LinkOut - more resources