OBJECTIVES: Treatment resistant depression (TRD) is generally defined as failure to respond to ≥2 different antidepressants, received at an adequate dose for adequate duration, in the same major depressive episode.¹ The European Observational TRD Cohort study aimed to examine treatment patterns and outcomes among TRD patients in Europe.² Here, the objective was to report the most commonly received treatments at baseline in this study population.

METHODS: A prospective, multicentre, observational cohort study of adults with TRD in Europe was conducted. At baseline, patients had a Montgomery-Åsberg Depression Rating Scale score ≥20, had failed ≥2 oral antidepressants and were initiating a new treatment for depression. Medical records, clinician-rated interviews and patient-reported questionnaires were used to collect patient characteristics and medical history. For patients receiving combination or augmentation therapies, multiple treatments were recorded at baseline.

RESULTS: In total, 411 patients were included, reporting 54 different drugs used at baseline. Nine drugs were received by ≥10% of patients: venlafaxine (24.8%), mirtazapine (21.2%), quetiapine (14.1%), bupropion (14.1%), duloxetine (14.1%), vortioxetine (13.1%), sertraline (10.9%), escitalopram (10.9%) and trazodone (10.2%). Of these, all were oral antidepressants except quetiapine, an antipsychotic. Of the eight oral antidepressants received by ≥10% of patients, two were selective serotonin reuptake inhibitors (sertraline and escitalopram), two were serotonin‑norepinephrine reuptake inhibitors (venlafaxine and duloxetine), and four were recorded as ‘other’ (trazodone, bupropion, mirtazapine and vortioxetine).

CONCLUSIONS: In this study, the pharmacological treatments used at baseline were varied, reflecting the heterogeneity of TRD and its treatment. Most received treatments were predominantly oral antidepressants, however, the third most received treatment was quetiapine, mainly used in clinical practice as an augmentation therapy, suggesting it is a routine treatment for patients with TRD.

ACKNOWLEDGEMENTS:

Editorial services (Costello Medical) and study funded by Janssen.

REFERENCES:

1. EMA. 2013; EMA/CHMP/185423/2010 Rev 2; 2. Heerlein K. JAD 2021;290:334–44.