Aligning the many definitions of treatment resistance in anxiety disorders: A systematic review

Research output: Contribution to journalReview articleAcademicpeer-review

Abstract

Anxiety Disorders often show a chronic course, even when treated with one of the various effective treatments available. Lack of treatment effect could be due to Treatment Resistance (TR). Consensus on a definition for TR Anxiety Disorders (TR-AD) is highly needed as currently many different operationalizations are in use. Therefore, generalizability in current TR-AD research is suboptimal, hampering improvement of clinical care. The objective of this review is to evaluate the currently used definitions of TR-AD by performing a systematic review of available literature. Out of a total of n = 13 042, 62 studies that operationalized TR-AD were included. The current review confirms a lack of consensus on TR-AD criteria. In 62.9% of the definitions, TR was deemed present after the first treatment failure. Most studies (93.0%) required pharmacological treatment failures, whereas few (29.0%) required psychological treatment failures. However, criteria for what constitutes “treatment failure” were not provided in the majority of studies (58.1%). Definitions for minimal treatment duration ranged from at least 4 weeks to at least 6 months. Almost half of the TR-AD definitions (46.8%) required elevated anxiety severity levels in TR-AD. After synthesis of the results, the consensus definition considers TR-AD present after both at least one first-line pharmacological and one psychological treatment failure, provided for an adequate duration (at least 8 weeks) with anxiety severity remaining above a specified threshold. This definition could contribute to improving course prediction and identifying more targeted treatment options for the highly burdened subgroup of TR-AD patients.
Original languageEnglish
Pages (from-to)801-812
Number of pages12
JournalDepression and Anxiety
Volume36
Issue number9
DOIs
Publication statusPublished - 1 Sep 2019

Cite this

@article{a5c28f4ff0db48b29e9a9a277d0dab93,
title = "Aligning the many definitions of treatment resistance in anxiety disorders: A systematic review",
abstract = "Anxiety Disorders often show a chronic course, even when treated with one of the various effective treatments available. Lack of treatment effect could be due to Treatment Resistance (TR). Consensus on a definition for TR Anxiety Disorders (TR-AD) is highly needed as currently many different operationalizations are in use. Therefore, generalizability in current TR-AD research is suboptimal, hampering improvement of clinical care. The objective of this review is to evaluate the currently used definitions of TR-AD by performing a systematic review of available literature. Out of a total of n = 13 042, 62 studies that operationalized TR-AD were included. The current review confirms a lack of consensus on TR-AD criteria. In 62.9{\%} of the definitions, TR was deemed present after the first treatment failure. Most studies (93.0{\%}) required pharmacological treatment failures, whereas few (29.0{\%}) required psychological treatment failures. However, criteria for what constitutes “treatment failure” were not provided in the majority of studies (58.1{\%}). Definitions for minimal treatment duration ranged from at least 4 weeks to at least 6 months. Almost half of the TR-AD definitions (46.8{\%}) required elevated anxiety severity levels in TR-AD. After synthesis of the results, the consensus definition considers TR-AD present after both at least one first-line pharmacological and one psychological treatment failure, provided for an adequate duration (at least 8 weeks) with anxiety severity remaining above a specified threshold. This definition could contribute to improving course prediction and identifying more targeted treatment options for the highly burdened subgroup of TR-AD patients.",
keywords = "CBT/ cognitive behavioral therapy, anxiety disorders, assessment/diagnosis, pharmacotherapy, treatment resistance",
author = "Bokma, {Wicher A.} and Wetzer, {Guido A. A. M.} and Gehrels, {Jurriaan B.} and Penninx, {Brenda W. J. H.} and Batelaan, {Neeltje M.} and {van Balkom}, {Anton L. J. M.}",
year = "2019",
month = "9",
day = "1",
doi = "10.1002/da.22895",
language = "English",
volume = "36",
pages = "801--812",
journal = "Depression and Anxiety",
issn = "1091-4269",
publisher = "Wiley-Blackwell",
number = "9",

}

Aligning the many definitions of treatment resistance in anxiety disorders: A systematic review. / Bokma, Wicher A.; Wetzer, Guido A. A. M.; Gehrels, Jurriaan B.; Penninx, Brenda W. J. H.; Batelaan, Neeltje M.; van Balkom, Anton L. J. M.

In: Depression and Anxiety, Vol. 36, No. 9, 01.09.2019, p. 801-812.

Research output: Contribution to journalReview articleAcademicpeer-review

TY - JOUR

T1 - Aligning the many definitions of treatment resistance in anxiety disorders: A systematic review

AU - Bokma, Wicher A.

AU - Wetzer, Guido A. A. M.

AU - Gehrels, Jurriaan B.

AU - Penninx, Brenda W. J. H.

AU - Batelaan, Neeltje M.

AU - van Balkom, Anton L. J. M.

PY - 2019/9/1

Y1 - 2019/9/1

N2 - Anxiety Disorders often show a chronic course, even when treated with one of the various effective treatments available. Lack of treatment effect could be due to Treatment Resistance (TR). Consensus on a definition for TR Anxiety Disorders (TR-AD) is highly needed as currently many different operationalizations are in use. Therefore, generalizability in current TR-AD research is suboptimal, hampering improvement of clinical care. The objective of this review is to evaluate the currently used definitions of TR-AD by performing a systematic review of available literature. Out of a total of n = 13 042, 62 studies that operationalized TR-AD were included. The current review confirms a lack of consensus on TR-AD criteria. In 62.9% of the definitions, TR was deemed present after the first treatment failure. Most studies (93.0%) required pharmacological treatment failures, whereas few (29.0%) required psychological treatment failures. However, criteria for what constitutes “treatment failure” were not provided in the majority of studies (58.1%). Definitions for minimal treatment duration ranged from at least 4 weeks to at least 6 months. Almost half of the TR-AD definitions (46.8%) required elevated anxiety severity levels in TR-AD. After synthesis of the results, the consensus definition considers TR-AD present after both at least one first-line pharmacological and one psychological treatment failure, provided for an adequate duration (at least 8 weeks) with anxiety severity remaining above a specified threshold. This definition could contribute to improving course prediction and identifying more targeted treatment options for the highly burdened subgroup of TR-AD patients.

AB - Anxiety Disorders often show a chronic course, even when treated with one of the various effective treatments available. Lack of treatment effect could be due to Treatment Resistance (TR). Consensus on a definition for TR Anxiety Disorders (TR-AD) is highly needed as currently many different operationalizations are in use. Therefore, generalizability in current TR-AD research is suboptimal, hampering improvement of clinical care. The objective of this review is to evaluate the currently used definitions of TR-AD by performing a systematic review of available literature. Out of a total of n = 13 042, 62 studies that operationalized TR-AD were included. The current review confirms a lack of consensus on TR-AD criteria. In 62.9% of the definitions, TR was deemed present after the first treatment failure. Most studies (93.0%) required pharmacological treatment failures, whereas few (29.0%) required psychological treatment failures. However, criteria for what constitutes “treatment failure” were not provided in the majority of studies (58.1%). Definitions for minimal treatment duration ranged from at least 4 weeks to at least 6 months. Almost half of the TR-AD definitions (46.8%) required elevated anxiety severity levels in TR-AD. After synthesis of the results, the consensus definition considers TR-AD present after both at least one first-line pharmacological and one psychological treatment failure, provided for an adequate duration (at least 8 weeks) with anxiety severity remaining above a specified threshold. This definition could contribute to improving course prediction and identifying more targeted treatment options for the highly burdened subgroup of TR-AD patients.

KW - CBT/ cognitive behavioral therapy

KW - anxiety disorders

KW - assessment/diagnosis

KW - pharmacotherapy

KW - treatment resistance

UR - https://www.scopus.com/inward/record.uri?partnerID=HzOxMe3b&scp=85068083459&origin=inward

UR - https://www.ncbi.nlm.nih.gov/pubmed/31231925

U2 - 10.1002/da.22895

DO - 10.1002/da.22895

M3 - Review article

VL - 36

SP - 801

EP - 812

JO - Depression and Anxiety

JF - Depression and Anxiety

SN - 1091-4269

IS - 9

ER -