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Treatment-refractory depression: definitions and characteristics
R M Berman1, M Narasimhan, D S Charney
1Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA. robert.berman@yale.edu
Depression and Anxiety
|January 1, 1997
Summary
Many patients with depression do not achieve remission with initial treatments, defining treatment-refractory depression (TRD). Current diagnostic systems struggle to predict which patients will respond to subsequent therapies.
Area of Science:
- Neuroscience
- Psychiatry
- Clinical Medicine
Background:
- A significant portion of patients with depression (40-50%) do not achieve remission with initial antidepressant medications or electroconvulsive therapy.
- This non-response defines treatment-refractory depression (TRD), characterized by inadequate response to adequate treatment trials.
Purpose of the Study:
- To outline a methodical approach for evaluating patients with apparent treatment-refractory depression.
- To highlight the challenges in predicting treatment response and the limitations of current diagnostic systems for TRD.
Main Methods:
- Systematic review of factors contributing to non-response in TRD.
- Analysis of the diagnostic and prognostic utility of current phenomenological approaches.
Main Results:
- Key factors for apparent non-response include trial adequacy, patient compliance, differential diagnosis, and comorbid conditions.
- Predictors for selecting subsequent antidepressant treatments for TRD are limited, often leading to choices based on safety and convenience rather than differential efficacy.
Conclusions:
- A structured approach is necessary to identify true treatment resistance after addressing potential confounding factors.
- Treatment-refractory depression poses a significant challenge to the prognostic accuracy of current diagnostic frameworks, necessitating further research into predictive biomarkers.