Latin American Consensus Recommendations on TRD: ECT Included in Text, Not Algorithm

Out on PubMed, from authors mainly in South America, is this article:

Latin American consensus recommendations for the management and treatment of patients with treatment-resistant depression (TRD).

Corral R, Bojórquez E, Cetkovich-Bakmas M, Córdoba R, Chestaro J, Gama C, Bonetto GG, Jaramillo CL, Moreno RA, Ng B, de Leon EP, Risco L, Silva H, Vazquez G.Span J Psychiatry Ment Health. 2023 Sep 22:S2950-2853(23)00013-3. doi: 10.1016/j.sjpmh.2023.06.001. Online ahead of print.PMID: 38592432

The abstract is copied below:

Despite the abundance of literature on treatment-resistant depression (TRD), there is no universally accepted definition of TRD, and available treatment pathways for the management of TRD vary across the Latin American region, highlighting the need for a uniform definition and treatment principles to optimize the management of TRD in Latin America.

Methods: Following a thematic literature review and pre-meeting survey, a Latin America expert panel comprising 14 psychiatrists with clinical experience in managing patients with TRD convened and utilized the RAND/UCLA appropriateness method to develop consensus-based recommendations on the appropriate definition of TRD and principles for its management.

Results: The expert panel agreed that 'treatment-resistant depression' (TRD) is defined as 'failure of two drug treatments of adequate doses, for 4-8 weeks duration with adequate adherence, during a major depressive episode'. A stepwise treatment approach should be employed for the management of TRD - treatment strategies can include maximizing dose, switching to a different class, and augmenting or combining treatments. Nonpharmacological treatments, such as electroconvulsive therapy, are also appropriate options for patients with TRD.

Conclusion: These consensus recommendations on the operational definition of TRD and approved treatments for its management can be adapted to local contexts in the Latin American countries but should not replace clinical judgement. Individual circumstances and benefit-risk balance should be carefully considered while determining the most appropriate treatment option for patients with TRD.

Keywords: Antidepressants; Differential diagnosis; Electroconvulsive therapy; Major depressive disorder; Treatment-resistant depression.

The article is here:

And from the text:

Here is a consensus statement from Latin American psychiatrists. ECT gets pretty good mention in the text, but does not make the grade for the figured algorithm. 

One interesting point is to note the high relapse rate after AD medication; ECT is not alone in this respect.

When I read this, it seemed to me that intranasal esketamine was given a lot of kudos; when I got to the end of the paper I saw that Jannsen supported the consensus process.