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A feasibility study on an automated identification of potential patients with treatment resistant depression (TRD) for studies being run in Oxford.

TRD is common and it is disabling. There is relatively little certainty about how it should best be treated. As a result, there has been an increased focus recently on trials which assess novel interventions and which explore biological mechanistic processes   related to TRD. These trials, many of which are run in Oxford, require patients with TRD to be identified and, where appropriate, invited to enrol in the studies. It may be possible to facilitate this process by searching Electronic Health Records (EHR) HER   databases such as the Clinical Records Information System (CRIS) system. In the first instance, the feasibility of this approach depends on being able to identify, using available search mechanisms, patients who are likely to be suitable for running studies. This study will assess this using de-identified data.

The study aims to iteratively arrive at an effective search strategy—iterations will involve running a search on patients, identifying patients found by the search who are unlikely to be suitable for enrolment in studies and using this information to improve the next generation of search. A search strategy will be developed and will be used to identify potential study patients, based on treatment (antidepressant) names mentioned in the EHR and ongoing contact with clinical teams. The suggested cohort of potentially suitable patients will be assessed for suitability (or not) for trial enrolment by trial clinicians. The trial clinicians will narratively describe the barriers to likely recruitment in identified patients and will discuss these with the information technician to assess whether it may be possible to improve the search strategy. This process will continue until either no improvement in search occurs or an acceptable hit rate (i.e. % of identified patients likely to be reasonable candidates for ongoing studies) is obtained.

Prevalence of Treatment Resistant Depression (TRD) in Child and Adolescent Mental Health Services (CAMHS) for 11-18 year olds

Depression in adolescence is relatively common and, unfortunately, in certain cases difficult to treat with either medication, such as antidepressants, or psychological treatments such as counselling and CBT. We are unclear how often treatment fails in the first instance and resistance occurs. It is important to know this, so that we can understand how big the problem is and, importantly, look at ways of improving our treatments for depression in this age group.

Difficult to Treat Depression 

This external study request, aims to identify the prevalence of difficult to treat depression (DTD) across the UK, understand a range of metrics on healthcare utilization (admissions, medication, treatments) and patient outcomes (suicidality, employment status). It will compare the identified DTD cohort to the larger non-DTD cohort (i.e. patients who haven’t failed treatment but have been diagnosed with depression) to understand the excess cost of DTD depression and identify other variables (aside failed treatments) that could be used to identify DTD individuals. This study will be used to inform commissioners about the current burden of disease and access to further treatment options.

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This is a prescribed app. It should only be used alongside a face to face intervention provided by a mental health worker. Check with your local service to see if they subscribe to the app.