Editorial: Treatment resistant depression (TRD): epidemiology, clinic, burden and treatment

Abstract

disorders can be episodic or recurrent, depending on clinical, personal and social variables (McIntyre et al., 2023;Sampogna et al., 2024).Most patients with major depression report an incomplete and inadequate clinical remission, with many residual symptoms, cognitive dysfunctions and working impairment (Luciano et al., 2023;Demyttenaere, 2019); up to one out of three patients do not fully respond to currently available treatments. According to the FDA and EMA, patients are considered to have treatment-resistant depression (TRD) when they fail to respond to ≥2 successive adequate trials of antidepressants in a single episode (FDA, 2019; EMA, 2020). The terminology, definition and clinical usefulness of the concept TRD is debatable for multiple reasons (Demyttenaere & Van Duppen, 2018). First, difficult-to-treat depression or (multiple) treatment failure are probably less stigmatizing terms. Second, it has been demonstrated that there are no meaningful cut-offs between patients having experienced 2, 3 or 4 consecutive failures suggesting more continuous 'staging models' of treatment failures.Third, we lack studies to scientifically guide clinicians on what to do after 1, 2, 3 or more treatment failures (guidelines are rather consensus based than evidence based). Despite these conceptual comments, TRD is a common condition, with a prevalence rate ranging from 30-to 40% of patients treated with antidepressants, and it is associated with high levels of personal and societal burden. Treatment-resistant depression is associated with a significant burden for patients, caregivers and families, increasing disability and worsening quality of life. Although several sociodemographic, contextual and psychological factors Given the high number of submissions and of accepted papers of extremely good quality, we can definitely consider that the present research topic has been extremely successful.However, despite a growing interest on TRD (from its definition to the diagnosis and to treatment options), information collected cannot be considered as conclusive yet, but can represent the basis for future studies. We are extremely grateful to all researchers, patients and caregivers that have participated in these studies, and we are committed to further increase the knowledge in the field.

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