ArticleJournal of psychopharmacology (Oxford, England)2022
The burden associated with, and management of, difficult-to-treat depression in patients under specialist psychiatric care in the United Kingdom.
Article in Journal of psychopharmacology (Oxford, England), 2022. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 11 papers.
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Who cites it
11 citing papers in PubMed, 20 citations in OpenAlex.
- Natural Language Processing Applied to Psychiatric Clinical Notes: Scoping Review.JMIR medical informatics · 2026Article
- Examining the needs, outcomes and current treatment pathways of 2461 people with treatment-resistant depression: mixed-methods study.The British journal of psychiatry : the journal of mental science · 2026Article
- AI assisted triage of UK patients in mental health care services: a qualitative focus group study of patients' attitudes.BMC psychiatry · 2026Article
- The Use of Vagus Nerve Stimulation (VNS) in the Management of Patients with Difficult-to-Treat Major Depressive Disorder (MDD): An Expert Consensus Statement.Neuropsychiatric disease and treatment · 2026Article
- Electroconvulsive therapy modulates the interplay between depressive symptoms in difficult-to-treat depression: A longitudinal network analysis.European psychiatry : the journal of the Association of European Psychiatrists · 2025Article
- Treatment-resistant or difficult-to-treat depression: a consensus on the pharmacotherapy challenges and considerations for the health care system in Greece.Frontiers in psychiatry · 2025Article
- Comorbidity, Treatment, and Service Utilization Patterns in Difficult-to-Treat Depression Patients: A Retrospective Study in a Portuguese Community Mental Health Team.Medicina (Kaunas, Lithuania) · 2024Observational
- Akrivia Health Database-deep patient characterisation using a secondary mental healthcare dataset in England and Wales: cohort profile.BMJ open · 2024Article
- Peer-led intervention for individuals with major depression: study protocol for a randomized controlled trial (SUPEERMood).BMC psychiatry · 2024Article
- Treatment-resistant depression: definition, prevalence, detection, management, and investigational interventions.World psychiatry : official journal of the World Psychiatric Association (WPA) · 2023Article
- Difficult-To-Treat Depression. Scoping Review.Clinical neuropsychiatry · 2023Article
Corrections and comments
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Authors and funding
9 authors at 2 institutions in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundMajor depressive disorder (MDD) is common and often has sub-optimal response to treatment. Difficult-to-treat depression (DTD) is a new concept that describes 'depression that continues to cause significant burden despite usual treatment efforts'.
aimsTo identify patients with likely DTD in UK secondary care and examine demographic, disease and treatment data as compared with 'non-DTD' MDD patients.
methodsAnonymised electronic health records (EHRs) of five specialist mental health National Health Service (NHS) Trusts in the United Kingdom were analysed using a natural language processing model. Data on disease characteristics, comorbidities and treatment histories were extracted from structured fields and using natural language algorithms from unstructured fields. Patients with MDD aged ⩾18 years were included in the analysis; those with presumed DTD were identified on the basis of MDD history (duration and recurrence) and number of treatments prescribed.
resultsIn a sample of 28,184 patients with MDD, 19% met criteria for DTD. Compared to the non-DTD group, patients with DTD were more likely to have severe depression, suicidal ideation, and comorbid psychiatric and/or physical illness, as well as higher rates of hospitalisation. They were also more likely to be in receipt of unemployment and sickness/disability benefits. More intensive treatment strategies were used in the DTD group, including higher rates of combination therapy, augmentation, psychotherapy and electroconvulsive therapy.
conclusionThis study demonstrates the feasibility of identifying patients with probable DTD from EHRs and highlights the increased burden associated with MDD in these patients.
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