Delphi panel to obtain clinical consensus regarding the importance of rapid reduction in depressive symptoms in patients with major depressive disorder with acute suicidal ideation or behavior (MDSI)
Bibliographic record
Abstract
Abstract Background: Though oral antidepressants can be effective at reducing depressive symptoms, they can take 4–6 weeks to reach full effect. Limitations relating to slow onset of action and resistance to current treatments for patients with major depressive disorder (MDD), particularly for MDD in a psychiatric emergency such as major depressive disorder with acute suicidal ideation or behavior (MDSI), is an issue across all countries and healthcare settings. Due to the current unmet needs and slow onset of action from oral antidepressants, patients with MDSI need interventions that provide a rapid relief of depressive symptoms. This study aimed to identify unmet needs in the treatment for MDSI, specifically exploring the potential clinical benefits of a rapid reduction of depressive symptoms, associated with treatment with rapid acting antidepressant such as esketamine nasal spray. Methods: A Delphi panel consisting of independent psychiatrists experienced in treating patients with MDSI (n=12) from the United States, Canada, United Kingdom, and European Union, was conducted between December 2020–June 2021. Psychiatrists were recruited and screened by an independent party to ensure that they had the required experience. Psychiatrists completed two rounds of anonymized questionnaires, and a virtual consensus meeting to collect their perceptive on current treatments for MDSI. Results: This research confirmed current unmet needs in the treatment of patients with MDSI. Hopelessness, functional impairment, worsening of symptoms, recurrent hospitalization and higher risk of suicide attempt were considered key consequences of the slow onset of action of oral antidepressants. Psychiatrists anticipated that treatment with rapid-acting antidepressants would provide benefits such as shorter hospital stays, improved patient engagement/compliance, and improved patient outcomes. For long-term benefits, psychiatrists agreed that improved daily functioning and increased trust/confidence in treatment options were key benefits of rapid-acting antidepressants. Conclusions: These findings suggest that the use of rapid-acting antidepressants such as esketamine nasal spray, in a psychiatric emergency, may help alleviate some of the current unmet needs experienced by patients with MDSI. This Delphi panel of psychiatrists highlighted that treatment with rapid-acting antidepressants can provide clinically meaningful benefits in the and long-term, as well as the immediate- and short-term, for patients with MDSI.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.068 | 0.081 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.001 | 0.002 |
| Bibliometrics | 0.002 | 0.001 |
| Science and technology studies | 0.004 | 0.002 |
| Scholarly communication | 0.002 | 0.002 |
| Open science | 0.002 | 0.010 |
| Research integrity | 0.003 | 0.004 |
| Insufficient payload (model declined to judge) | 0.007 | 0.002 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".