| Study | Population | Intervention | Comparison | Details of inadequate response/treatment resistance | Comments |
|---|---|---|---|---|---|
|
RCT China |
N=50 Mean age (years): 46.2 Gender (% female): 76 Ethnicity (% BME): NR Baseline severity: HAMD 11.91 (less severe) |
CBT group + any antidepressant Intensity: 10x 90-min sessions | Waitlist + any antidepressant | Inadequate response: participants met inclusion criteria despite all receiving antidepressants at baseline |
Treatment length (weeks): 10 Outcomes:
|
|
RCT Italy |
N=50 Mean age (years): 49.0 Gender (% female): 72 Ethnicity (% BME): NR Baseline severity: HAMD 16.4 (more severe) |
Mindfulness-based cognitive therapy (MBCT) group + any antidepressant Intensity: 8x 2-hour weekly sessions |
Attention-placebo (psychoeducational control group) + any antidepressant Intensity: 8x 2-hour weekly sessions | Inadequate response (failure to achieve remission, HAMD score≥8) to treatment with antidepressants at adequate dosages for at least 8 weeks before study beginning |
Treatment length (weeks): 8 Outcomes:
|
|
RCT Canada |
N=48 Mean age (years): 46.5 Gender (% female): 74 Ethnicity (% BME): 2 Baseline severity: HAMD 19.72 (more severe) |
CBT individual + any antidepressant Intensity: 15x 1-hour sessions | Waitlist + any antidepressant | Inadequate response: participants met inclusion criteria despite all receiving antidepressants at baseline |
Treatment length (weeks): 15 Outcomes:
|
|
RCT Canada |
N=24 Mean age (years): NR Gender (% female): 70 Ethnicity (% BME): NR Baseline severity: BDI 22.5 (more severe) |
CBT individual + TCA Intensity: 16x twice-weekly sessions | Waitlist + TCA | Inadequate response to current TCA treatment |
Treatment length (weeks): 8 Outcomes:
|
|
RCT US |
N=173 Mean age (years): 46.2 Gender (% female): 76 Ethnicity (% BME): 20 Baseline severity: HAMD 17.9 (more severe) |
Mindfulness-based cognitive therapy (MBCT) group + any antidepressant Intensity: 8x 2.25-hour weekly sessions |
Attention-placebo (health enhancement programme) + any AD antidepressant Intensity: 8x 2.25-hour weekly sessions | TRD: Inadequate response to 2 or more adequate trials prescribed during the current episode assessed with the Antidepressant Treatment History Form (ATHF) |
Treatment length (weeks): 8 Outcomes:
|
|
RCT UK |
N=38 Mean age (years): NR Gender (% female): NR Ethnicity (% BME): NR Baseline severity: BDI-II 31 (more severe) |
CBT group + any antidepressant Intensity: 12x 60-90 min sessions | Waitlist + any antidepressant | Inadequate response: participants met inclusion criteria despite taking antidepressants for at least 1 month prior to study entry |
Treatment length (weeks): 8 Outcomes:
|
|
RCT US |
N=296 Mean age (years): 44.6 Gender (% female): 54 Ethnicity (% BME): 11 Baseline severity: HAMD 19.15 (more severe) |
Cognitive behavioral analysis system of psychotherapy (CBASP) + any antidepressant Intensity: 16-20 sessions | Any antidepressant | Inadequate response (≥60% reduction in HAMD score, a HAMD total score<8, and no longer meeting DSM-IV criteria for MDD for 2 consecutive visits during weeks 6-12) to 12 weeks of antidepressant medication according to a pharmacotherapy algorithm |
Treatment length (weeks): 12 Outcomes:
|
|
RCT US |
N=35 Mean age (years): 61.4 Gender (% female): 46 Ethnicity (% BME): 14 Baseline severity: HAMD 16.53 (more severe) |
Dialectical behaviour therapy (DBT) + any antidepressant Intensity: 24x individual sessions + 24x group sessions | Any antidepressant | Inadequate response (HAMD score>10) to 8 weeks of prospective treatment with physician choice of SSRI |
Treatment length (weeks): 24 Outcomes:
|
|
RCT Japan |
N=80 Mean age (years): 40.6 Gender (% female): 36 Ethnicity (% BME): NR Baseline severity: HAMD 20.9 (more severe) |
CBT individual + any antidepressant Intensity: 16x 50-min sessions (+4 additional sessions if appropriate) | Any antidepressant | Inadequate response: at least a minimal degree of treatment-resistant depression (Maudsley Staging Method for treatment-resistant depression score≥3) and HAMD score≥16 despite having received adequate therapeutic levels of antidepressant medication for at least 8 weeks as part of their routine care |
Treatment length (weeks): 16 Outcomes:
|
|
RCT Japan |
N=40 Mean age (years): 40.2 Gender (% female): 50 Ethnicity (% BME): NR Baseline severity: HAMD 18.4 (more severe) |
Blended computerised CBT and individual face-to-face CBT + any antidepressant Intensity: 12 online modules + 12x 45-min face-to-face sessions | Waitlist + any antidepressant | Inadequate response: HAMD score ≥14 despite having received adequate therapy with ≥1 antidepressant medications for at least 6 weeks as part of their routine care |
Treatment length (weeks): 12 Outcomes:
|
|
RCT UK |
N=158 Mean age (years): 43.4 Gender (% female): 49 Ethnicity (% BME): NR Baseline severity: HAMD 12.2 (less severe) |
CBT individual + any antidepressant Intensity: 16 sessions | Any antidepressant | Inadequate response (HAMD≥8 and BDI≥9) to antidepressant medication for at least the previous 8 weeks, with at least 4 weeks at an adequate dose |
Treatment length (weeks): 20 Outcomes:
|
|
RCT UK |
N=28 Mean age (years): 43 Gender (% female): 71 Ethnicity (% BME): NR Baseline severity: BDI-II 39.11 (more severe) |
Person-based cognitive therapy (PBCT) group + any antidepressant Intensity: 12x 90-min sessions | Any antidepressant | Inadequate response: met inclusion criteria despite requirement to have been on stable antidepressant treatment for at least 3 months |
Treatment length (weeks): 12 Outcomes:
|
|
RCT UK |
N=42 Mean age (years): 44.2 Gender (% female): 57 Ethnicity (% BME): 5 Baseline severity: HAMD 12.7 (less severe) |
Rumination-focused CBT + SSRI/SNRI Intensity: 12 sessions | SSRI/SNRI | Inadequate response (HAMD score≥8 and BDI-II score≥9) to antidepressant medication taken at a therapeutic dose as recommended by the BNF and/or equivalent to 125 mg of amitriptyline for at least 8 weeks continuously during the current episode and within the past 2 months |
Treatment length (weeks): 26 Outcomes:
|
|
RCT UK |
N=25 Mean age (years): 45.3 Gender (% female): 84 Ethnicity (% BME): NR Baseline severity: BDI-II 29.21 (less severe) |
CBT individual + SSRI Intensity: 12-20 sessions | SSRI | Inadequate response (BDI-II≥15) despite having taken antidepressant medication for at least 6 weeks at recommended (BNF) doses |
Treatment length (weeks): 17 Outcomes:
|
|
RCT UK |
N=469 Mean age (years): 49.6 Gender (% female): 72 Ethnicity (% BME): 2 Baseline severity: BDI-II 31.8 (more severe) |
CBT individual + any antidepressant Intensity: 12x 50-60min sessions (+6 sessions if judged to be clinically appropriate) | Any antidepressant | Inadequate response (BDI-II≥14) to an adhered to, adequate dose of antidepressant medication (based on BNF and advice from psychopharmacology experts) for at least 6 weeks |
Treatment length (weeks): 26 Outcomes:
|
BDI/BDI-II: Beck depression inventory; BME: black and minority ethnic; BNF: British national formulary; CBT: cognitive behavioural therapy; DSM: diagnostic statistical manual; HAMD: Hamilton depression scale; MDD: major depressive disorder; NR: not reported; RCT: randomised controlled trial; SNRI: serotonin–norepinephrine reuptake inhibitor; SSRI: selective serotonin reuptake inhibitor; TCA: tricyclic antidepressant; TRD: treatment-resistant depression
From: Further-line treatment
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