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Disponible online el 10 de noviembre de 2023
Latin American consensus recommendations for the management and treatment of patients with treatment-resistant depression (TRD)
Ricardo Corrala, Enrique Bojórquezb, Marcelo Cetkovich-Bakmasc, Rodrigo Córdobad, Julio Chestaroe,f, Clarissa Gamag, Gerardo García Bonettoh, Carlos López Jaramilloi, Ricardo Alberto Morenoj, Bernardo Ngk, Edilberto Pena de Leonl, Luis Riscom, Hernán Silvam, Gustavo Vazquezn,o,
Autor para correspondencia
g.vazquez@queensu.ca

Corresponding author.
a Department of Psychiatry, Jose T. Borda Hospital, University of Buenos Aires, Buenos Aires, Argentina
b Mayor University of San Marcos, Peru
c Institute of Cognitive and Translational Neurosciences (INCyT), INECO Foundation, Favaloro University, Buenos Aires, Argentina
d UR Center for Mental Health – CeRSaME, School of Medicine and Health Sciences – EMCS, University of Rosario, Bogotá, Colombia
e Catholic University of Cibao, La Vega, Dominican Republic
f Traumatological Hospital Juan Bosch, La Vega, Dominican Republic
g Department of Psychiatry and Legal Medicine, UFRGS, Research Unit, HCPA, Porto Alegre, Brazil
h Department of Psychiatry, Neuropsychiatric Provincial Hospital, Córdoba, Argentina
i Department of Psychiatry, School of Medicine, University of Antioquia, Medellin, Colombia
j Mood Disorders Unit (GRUDA), Institute of Psychiatry, University of Sao Paulo, Brazil
k Geriatric Center Nuevo Atardecer and Department of Psychiatry, University of California San Diego, Sun Valley Behavioral and Research Centers, California, USA
l Center of Investigations on the Central Nervous System, Mexico DF, Mexico
m Department of Psychiatry, Faculty of Medicine, University of Chile, Santiago, Chile
n Research Center on Neurosciences, University of Palermo, Buenos Aires, Argentina
o Department of Psychiatry, Queen's University, Kingston, Ontario, Canada
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Recibido 08 Febrero 2022. Aceptado 14 Junio 2023
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Table 1. Augmentation strategies for TRD, recommendations and level of evidence.
Abstract

Despite the abundance of literature on treatment-resistant depression (TRD), there is no universally accepted definition of TRD, and available treatment pathways for the management of TRD vary across the Latin American region, highlighting the need for a uniform definition and treatment principles to optimize the management of TRD in Latin America.

Methods

Following a thematic literature review and pre-meeting survey, a Latin America expert panel comprising 14 psychiatrists with clinical experience in managing patients with TRD convened and utilized the RAND/UCLA appropriateness method to develop consensus-based recommendations on the appropriate definition of TRD and principles for its management.

Results

The expert panel agreed that ‘treatment-resistant depression’ (TRD) is defined as ‘failure of two drug treatments of adequate doses, for 4–8 weeks duration with adequate adherence, during a major depressive episode’. A stepwise treatment approach should be employed for the management of TRD – treatment strategies can include maximizing dose, switching to a different class, and augmenting or combining treatments. Nonpharmacological treatments, such as electroconvulsive therapy, are also appropriate options for patients with TRD.

Conclusion

These consensus recommendations on the operational definition of TRD and approved treatments for its management can be adapted to local contexts in the Latin American countries but should not replace clinical judgement. Individual circumstances and benefit–risk balance should be carefully considered while determining the most appropriate treatment option for patients with TRD.

Keywords:
Treatment-resistant depression
Major depressive disorder
Differential diagnosis
Antidepressants
Electroconvulsive therapy

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