{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T01:30:47Z","timestamp":1760146247650,"version":"build-2065373602"},"reference-count":34,"publisher":"MDPI AG","issue":"11","license":[{"start":{"date-parts":[[2024,10,22]],"date-time":"2024-10-22T00:00:00Z","timestamp":1729555200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Medicina"],"abstract":"<jats:p>Background and Objectives: Observational studies with data from real-world clinical practice with patients with difficult-to-treat depression (DTD) are rare. This study aims to collect observational data from the real-world clinical practice of a Portuguese community mental health team (CMHT) on the prevalence of DTD and to explore differences between DTD and non-DTD groups. Materials and Methods: We conducted a retrospective chart review study using data from Electronic Health Records (EHRs) of adult patients with psychiatric disorders followed by a CMHT from the Department of Psychiatry of the Coimbra Local Health Unit (between 1 December 2020\u201331 December 2022). The Dutch Measure for quantification of Treatment Resistance in Depression (DM-TRD) was used to assess the degree of treatment resistance and the Charlson Comorbidity Index (CCI) to measure medical comorbidity. Results: A quantity of 473 patients were referred to Cantanhede CMHT for a first assessment. Of these, 219 patients met the criteria for a primary diagnosis of any depressive disorder. Assistant psychiatrists identified 57 patients with DTD during follow-up (approximately 26%). The DTD group had higher rates of depressive episodes, greater depression severity, increased service use, higher DM-TRD scores, and a higher prevalence of comorbid anxiety symptoms, personality disorders, and severe medical comorbidities. The DTD group also had a higher prescription rate of antidepressants. Differences were observed in the use of antidepressant augmentation strategies and in the prescription of anticoagulant\/antiplatelet drugs and analgesics, with higher prescription rates in the DTD group. We found correlations between DM-TRD and CCI scores, and between DM-TRD scores and all service use variables. Conclusions: Our results are consistent with a similar study in the United Kingdom, highlighting the need for a different approach to the management of DTD patients, who continue to live with a significant burden despite usual pharmacological and non-pharmacological treatments.<\/jats:p>","DOI":"10.3390\/medicina60111734","type":"journal-article","created":{"date-parts":[[2024,10,22]],"date-time":"2024-10-22T11:31:57Z","timestamp":1729596717000},"page":"1734","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Comorbidity, Treatment, and Service Utilization Patterns in Difficult-to-Treat Depression Patients: A Retrospective Study in a Portuguese Community Mental Health Team"],"prefix":"10.3390","volume":"60","author":[{"given":"Jo\u00e3o","family":"Gouveia","sequence":"first","affiliation":[{"name":"Faculty of Medicine, University of Coimbra (UC), 3004-531 Coimbra, Portugal"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Marta Moura","family":"Neves","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, University of Coimbra (UC), 3004-531 Coimbra, Portugal"},{"name":"Department of Psychiatry, Unidade Local de Sa\u00fade de Coimbra (ULS-C), 3004-561 Coimbra, Portugal"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5009-8841","authenticated-orcid":false,"given":"Nuno","family":"Madeira","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, University of Coimbra (UC), 3004-531 Coimbra, Portugal"},{"name":"Department of Psychiatry, Unidade Local de Sa\u00fade de Coimbra (ULS-C), 3004-561 Coimbra, Portugal"},{"name":"Coimbra Institute for Biomedical Imaging and Translational Research (CIBIT), Institute of Nuclear Sciences Applied to Health (ICNAS), University of Coimbra (UC), 3000-548 Coimbra, Portugal"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1945-4339","authenticated-orcid":false,"given":"V\u00edtor","family":"Santos","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, University of Coimbra (UC), 3004-531 Coimbra, Portugal"},{"name":"Department of Psychiatry, Unidade Local de Sa\u00fade de Coimbra (ULS-C), 3004-561 Coimbra, Portugal"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2180-2718","authenticated-orcid":false,"given":"Ant\u00f3nio","family":"Macedo","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, University of Coimbra (UC), 3004-531 Coimbra, Portugal"},{"name":"Department of Psychiatry, Unidade Local de Sa\u00fade de Coimbra (ULS-C), 3004-561 Coimbra, Portugal"},{"name":"Coimbra Institute for Biomedical Imaging and Translational Research (CIBIT), Institute of Nuclear Sciences Applied to Health (ICNAS), University of Coimbra (UC), 3000-548 Coimbra, Portugal"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2024,10,22]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"957","DOI":"10.1016\/S0140-6736(21)02141-3","article-title":"Time for United Action on Depression: A Lancet-World Psychiatric Association Commission","volume":"399","author":"Herrman","year":"2022","journal-title":"Lancet"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"44","DOI":"10.1038\/s41572-023-00454-1","article-title":"Major Depressive Disorder","volume":"9","author":"Marx","year":"2023","journal-title":"Nat. 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