Treatment of difficult-to-treat depression–clinical guideline for selected interventions

Research output: Contribution to journal/Conference contribution in journal/Contribution to newspaperReviewResearchpeer-review

  • Stine Bjerrum Moeller, University of Southern Denmark, Københavns Universitet
  • ,
  • Krzysztof Gbyl, University of Copenhagen
  • ,
  • Carsten Hjorthøj, University of Copenhagen
  • ,
  • Maike Andreasen, Aarhus University
  • ,
  • Stephen F. Austin, University of Southern Denmark
  • ,
  • Poul Erik Buchholtz
  • Line Fønss, University of Copenhagen
  • ,
  • Simon Hjerrild
  • Lise Hogervorst
  • ,
  • Martin Balslev Jørgensen, University of Copenhagen
  • ,
  • Nicolai Ladegaard
  • Klaus Martiny, Sydhavnens Medical Clinic
  • ,
  • Jonas Meile, Psychiatry Region Zealand
  • ,
  • Aake Packness, University of Southern Denmark, Aarhus University
  • ,
  • Karen Rodriguez Sigaard
  • Krista Straarup
  • Sune P.V. Straszek
  • Claus Havregaard Soerensen, Region Zealand Psychiatry
  • ,
  • Birgitte Welcher, Region Zealand Psychiatry
  • ,
  • Poul Videbech, University of Copenhagen

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.

Original languageEnglish
Book seriesNordic Journal of Psychiatry
Pages (from-to)177-188
Number of pages12
Publication statusPublished - 2022

Bibliographical note

Publisher Copyright:
© 2021 The Author(s). Published by Informa UK Limited, trading as Taylor & Francis Group.

    Research areas

  • affective disorders, Clinical guideline, persistent depressive disorder, refractory depression, treatment-resistant depression

See relations at Aarhus University Citationformats

ID: 272052079