Definition of Treatment-Resistant Depression in the Medicare Population
Project Summary Title and Description
- Definition of Treatment-Resistant Depression in the Medicare Population
- The purpose of this technology assessment is to review the current definitions of treatment-resistant depression (TRD), to assess how closely current TRD treatment studies fit the most common definition, and to suggest how to improve TRD treatment research.
- Authors of Report
- Methodology description
- Our search for Key Questions 1-5 looked at literature published from 1/1/1995 through 4/1/2017, and our search for Key Questions 6-11 looked at literature published from 1/1/2005 through 4/1/2017. We conducted systematic literature searches for publications indexed in MEDLINE®, EMBASE, PsycINFO, and Cochrane Library. Other materials searched included consensus statements, clinical practice guidelines, and relevant government reports; website sources were Clinicaltrials.gov, Guideline.gov (AHRQ’s National Guidelines Clearinghouse), HSRProj (Health Services Research Projects in Progress database), and UpToDate®. Eligible studies for Key Questions 1-5 considered all sources noted above (including systematic reviews) except for individual intervention trials; intervention trials were only eligible for Key Questions 6-11.
- All of the report's systematic review study data were entered retrospectively to SRDR, via direct file uploading as Word documents (one each for Key Questions 6, 7, 8, 9, and 11; two for Key Question 10).
- Funding Source
- This systematic review was proposed as a large Technology Assessment by the Centers for Medicare & Medicaid Services and conducted by the RTI-UNC Evidence-based Practice Center for the Agency for Healthcare Research and Quality.
- 1. What definitions of TRD appear in these sources and do definitions converge on a best one?
- 2. What methods do investigators use to diagnose this condition in clinical research, and does a consensus exist about the best ways to reach a clear diagnosis?
- 3. What measures (i.e., endpoints or outcomes) exist to determine the success or failure of treatment in TRD studies; what clinical focus do they represent (e.g., severity); what psychometric and other properties do they have?
- 4. What research designs do investigators use in TRD studies and does any consensus exist about best approaches to minimize bias and placebo effects and other elements of study design (e.g., length)?
- 5. What are the risk factors for TRD?
- 6. What are the inclusion criteria for patients in these studies, specifically concerning patient characteristics, prior treatments, and diagnostic characteristics?
- 7. How do these criteria compare or contrast with definitions encountered in the narrative review?
- 8. What were primary characteristics of included studies, such as design, run-in or wash-out periods, and length?
- 9. How were included studies designed to account for TRD risk factors identified in the narrative review?
- 10. What are relationships between risk factors and results of included TRD studies?
- 11. What variables or information did included studies report (e.g., patient outcomes, time to relapse, treatment adherence, attrition, and use of health care resources)?
Associated Extraction Forms
Associated Studies (each link opens a new tab)
Downloadable Data Content
- XLSX Project Data