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Table 1 The main definitions of treatment-resistance in depression

From: Standardisation framework for the Maudsley staging method for treatment resistance in depression

Year Source Definition Remarks
1974 WHO Failure of 150 mg of imipramine or equivalent given for 4 weeks Specifies dose and duration Also specifies relative and absolute resistance based on dose of imipramine (150 mg being the threshold for absolute resistance)
1997 Thase & Rush Failure of 1 adequately given antidepressant medication Primarily for staging; Assumes hierarchy
1999 Sourey et al Failure of 2 antidepressant medications from different classes Also called the European method; failure of 1 antidepressant medication defined as non-response; uses chronicity criteria for staging
2002 EMEA Failure of 2 medications from different classes Suggests remission as outcome criteria
2000/ 2005 APA Failure of 1 adequately given antidepressant medication given for 4–8 weeks Not attempt to define directly but implicit reference can be interpreted
2003 MGH Failure of 1 antidepressant medication? Primarily staging method
2007 NICE Failure of 2 antidepressant medication from different classes  
2008 BAP Failure of 2 antidepressant medication from different classes Refers to commonly used definitions instead of attempting to provide a definition of its own
2009 MSM Failure of 1 adequately given antidepressant medication Failure to achieve remission suggested as main outcome criteria; Primarily for staging
2015 DM-TRD Failure of 1 adequately given antidepressant medication Based on the MSM
2017 Conway et al Failure of 2 adequate dose-duration antidepressants or psychotherapy from different classes Antidepressants given in current episode. Combinations count individually
  1. Abbreviations: APA = American Psychiatric Association; BAP=British Association of Psychopharmacology; DM-TRD = The Dutch Measure for quantification of Treatment Resistance in Depression (DM-TRD); EMEA = The European Agency for the Evaluation of Medicinal Products; MGH = Massachusetts General Hospital (staging method); MSM = Maudsley Staging Method; NICE = National Institute for Health and Clinical Excellence; WHO=World Health Organisation
  2. (References provided in main text)