depressed patient having consultation psychotherapy treatment sessio

The Burden associated with, and management of difficult-to-treat depression in patients under specialist psychiatric care in the United Kingdom

Major depressive disorder (MDD) is common and often has sub-optimal response to treatment. Difficult-to-treat depression (DTD) is a new concept that describes ‘depression that continues to cause significant burden despite usual treatment efforts’.

To identify patients with likely DTD in UK secondary care and examine demographic, disease and treatment data as compared with ‘non-DTD’ MDD patients.

Anonymised electronic health records (EHRs) of five specialist mental health National Health Service (NHS) Trusts in the United Kingdom were analysed using a natural language processing model. Data on disease characteristics, comorbidities and treatment histories were extracted from structured fields and using natural language algorithms from unstructured fields. Patients with MDD aged ⩾18 years were included in the analysis; those with presumed DTD were identified on the basis of MDD history (duration and recurrence) and number of treatments prescribed.

In a sample of 28,184 patients with MDD, 19% met criteria for DTD. Compared to the non-DTD group, patients with DTD were more likely to have severe depression, suicidal ideation, and comorbid psychiatric and/or physical illness, as well as higher rates of hospitalisation. They were also more likely to be in receipt of unemployment and sickness/disability benefits. More intensive treatment strategies were used in the DTD group, including higher rates of combination therapy, augmentation, psychotherapy and electroconvulsive therapy.

This study demonstrates the feasibility of identifying patients with probable DTD from EHRs and highlights the increased burden associated with MDD in these patients.



1.Costa T, Menzat B, Engelthaler T, et al. The burden associated with, and management of, difficult-to-treat depression in patients under specialist psychiatric care in the United Kingdom. Journal of Psychopharmacology. 2022;36(5):545-556.