Panel 1. Overview of the characteristics of the Karolinska Institutet model (KIM), the European Staging Method (ESM), the Massachusetts General Hospital Staging Method (MGH-s), and the Maudsley Staging Method (MSM).
| KIM | ESM | MGH-s | MSM | ||
|---|---|---|---|---|---|
| Original version | TRD threshold or TRD severity points | TRD threshold | TRD threshold | TRD severity points (Total score = summation of each treatment trial) | TRD severity points (Total score = 3 to 15) |
| Number of treatment failures to be defined as TRD | 2 | 2 | 1 point per nonresponsive AD treatment episode | Level 1: 1–2 ADs = 1 point(s); | |
| Level 2: 3–4 ADs = 2; | |||||
| Level 3: 5–6 ADs = 3; | |||||
| Level 4: 7–10 ADs = 4; | |||||
| Level 5: >10 ADs = 5; | |||||
| Adequate length of treatment episode/dose | At least 28 days | NA | See S1 Table for definition of adequate dose | NA | |
| Required duration | NA | TRD1–12- to 16-weeks | At least 6 weeks | Acute (≤365 days) = 1 pointa | |
| TRD2–18- to 24-weeks duration | Subacute (13 to 24 months) = 2 pointsa | ||||
| Chronic (>24 months) = 3 pointsa | |||||
| TRD3–24- to 32-weeks duration | |||||
| TRD4–30- to 40-weeks duration | |||||
| TRD5–36- to 52-weeks duration | |||||
| Augmentation | NA | NA | 0.5 point for augmentation | 1 point | |
| Optimisation of dose | NA | NA | 0.5 point for optimisation | NA c | |
| ECT/rTMS | Counted as a treatment episode | NA | 3 point for ECT | 1 point for ECT | |
| Symptom severity | NA | NA | NA | Subsyndromalb = 1 point | |
| Mild = 2 points | |||||
| Moderate = 3 points | |||||
| Severe without psychosis = 4points | |||||
| Severe with psychosis = 5 points | |||||
| Adapted version for register data | TRD threshold or TRD severity points | Unchanged | Unchanged | TRD threshold (TRD definition threshold = total score ≥4 points) | TRD threshold (TRD definition threshold = total score ≥5) |
| Number of treatment failures to be defined as TRD | Unchanged | Unchanged | Nonresponse to each adequate (at least six weeks at an adequate dose) trial of an AD (1 point per trial)–See S1 Table for definition of adequate dose. | Treatment failures: | |
| 1–2 ADs = 1 point | |||||
| 3–4 ADs = 2 points | |||||
| 5–6 ADs = 3 points | |||||
| 7–10 ADs = 4 points | |||||
| >10 ADs = 5 points | |||||
| Adequate length of treatment episode/dose | Unchanged | At least 28 days | See S1 Table for definition of adequate dose. | At least 28 days | |
| Required duration | Unchanged | 12- to 16-week | Unchanged | NA | |
| Augmentation | Unchanged | Unchanged | Unchanged | Unchanged | |
| Optimisation of dose | Unchanged | Unchanged | Unchanged | NA c | |
| ECT/rTMS | Unchanged | Unchanged | Unchanged | Unchanged | |
| Symptom severity | Unchanged | Unchanged | Unchanged | ICD-10: Major depressive disorder: | |
| F32.0 and F33.0 mild = 2 points | |||||
| F32.1 and F33.1 moderate = 3 points | |||||
| F32.2 and F33.2 severe without psychotic features = 4 points | |||||
| F32.3 and F33.3 severe with psychotic features = 5 points |
a Duration cannot be used as in the original version since we have a one-year follow-up.
b Information not available in registers.
c Information on optimisation of dose, optimisation of duration not available in registers.
AD = Antidepressant; ECT = Electroconvulsive therapy; repetitive transcranial magnetic stimulation; rTMS = repetitive transcranial magnetic stimulation; TRD = treatment-resistant depression; CRD = chronic resistant depression; ICD = International Statistical Classification of Diagnoses; NA = not applicable.