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MRI-guided dmPFC-rTMS as a Treatment for Treatment-resistant Major Depressive Disorder
Published on: August 11, 2015
Identifying "paradigm failures" contributing to treatment-resistant depression
G B Parker1, G S Malhi, J G Crawford
1School of Psychiatry, University of New South Wales and Black Dog Institute, Prince of Wales Hospital, Randwick 2031, Sydney, Australia. g.parker@unsw.edu.au
Background:
"Treatment resistant depression" is likely to emerge from a number of factors, including application of the wrong diagnostic and treatment models.
Method:
Current paradigms for managing both depression and treatment resistant depression are considered. We then examine the prevalence of a set of paradigm failures that appeared to contribute to treatment resistant depression in outpatients of a tertiary referral Mood Disorders Unit.
Results:
Six illustrative paradigm failures are described and their frequencies within the clinical sample reported. Identified paradigm failures were diagnosing and/or managing a non-melancholic condition as if it were melancholic depression, failure to diagnose and manage bipolar disorder, psychotic depression or melancholic depression, misdiagnosing secondary depression and failure to identify organic determinants.
Conclusion:
We suggest that the identification of such "paradigm failures"--and of others that can be assumed to operate--has the potential to enrich the assessment and management of depressed patients, and reduce the prevalence of treatment resistance.
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