Table 2.
Summary of statements from the modified Delphi methodology
| Statement | Level of Agreement |
|---|---|
| Treatment‐resistant depression (TRD) as a categorical or dimensional definition | |
| A definition for TRD is currently being used in clinical practice by the expert. | 85% |
| TRD is a meaningful concept in clinical practice. | 92% |
| An operational definition for TRD is needed for clinicians and researchers. | 100% |
| TRD should be defined in a dimensional sense only | 92% |
| Definition of the initial stage of TRD | |
| TRD should be defined by the failure of two adequately dosed and evidence supported trials of antidepressant medications. | 83% |
| Nonresponse in TRD should be defined as less than 50% reduction in symptom severity | 83% |
| The minimum length of the antidepressant trial should be 4–6 weeks | 83% |
| Evaluation | |
| HAM‐D‐17 should be used in the ongoing assessment of depressive symptoms | 83% |
| Risk factors and comorbidities | |
| Anxiety comorbidity | 93% |
| Psychotic features | 93% |
| A higher number of lifetime depressive episodes | 100% |
| Partial remission | 92% |
| Number of lifetime episodes | 93% |
| Number of previous antidepressant trials | 92% |
| Number of previous augmentation agents | 86% |
| Previously failed psychotherapy | 100% |
| Previous failed ECT | 93% |
| The long duration of illness | 85% |
| Symptom severity of the current episode | 100% |
| Greater number of hospitalizations | 92% |
| Prevalence of comorbidities (psychiatric and medical) | 92% |
| Comorbid personality disorder | 92% |
| Comorbid medical illness | 86% |
| Comorbid substance use | 100% |
| Bipolarity features | 92% |
| Current psychosocial stressors | 93% |
| Assessment/staging models | |
| TRD staging models have clinical relevance in both clinical practice and research | 93% |
| The DM‐TRD is recommended as a clinical staging tool in TRD | 72% |
| The Maudsley staging model is recommended as a clinical staging tool in TRD | 45% |
Note: Statements were considered to have reached consensus if 80% or more of the experts rated the item as “agree” or “strongly agree.”
Abbreviations: DM‐TRD, Dutch measure for quantification of treatment resistance in depression; ECT, electroconvulsive therapy; HAM‐D‐17, Hamilton depression rating scale (17‐items).