title: Treatment-resistant depression: definition and treatment approaches.
abstract: Little systematic attention has been directed toward the subject of treatment-resistant depression. Although these patients constitute a distinct minority, their treatment consumes a major portion of the clinician's time. Thus, the authors address the problems of defining and treating the estimated 750,000 patients with treatment-resistant depression. Several major factors concerning treatment-resistant depression appear evident: (1) although there is an emerging consensus of what constitutes "adequate" treatment, the majority of patients receive suboptimal drug regimens; (2) misdiagnosis of depression subtypes can lead to suboptimal treatment and "pseudo-resistance" to drug therapy; (3) treatment strategies for resistant depression should use systematic algorithms to avoid confusion and limit "therapeutic nihilism" in the patient and physician; and (4) the patient's risk/benefit ratio for each successive treatment application must be considered with the potential benefit weighed against the increasing risk of illness morbidity and likelihood of adverse events and/or suicide.
authors.affiliation: Treatment Resistant Depression Program, McLean Hospital, Belmont, Mass.
authors.forename: A A
authors.initials: AA
authors.lastname: Nierenberg
authors.forename: J D
authors.initials: JD
authors.lastname: Amsterdam
mesh_terms: D000928:Antidepressive Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D000929:Antidepressive Agents, Tricyclic / Q000008:administration & dosage / Q000627:therapeutic use; D003866:Depressive Disorder / Q000175:diagnosis / Q000188:drug therapy* / Q000523:psychology; D004359:Drug Therapy, Combination; D005473:Fluoxetine / Q000008:administration & dosage / Q000627:therapeutic use; D006801:Humans; D008094:Lithium / Q000008:administration & dosage / Q000627:therapeutic use; D016651:Lithium Carbonate; D008996:Monoamine Oxidase Inhibitors / Q000008:administration & dosage / Q000627:therapeutic use
chemical_list: D000928:Antidepressive Agents; D000929:Antidepressive Agents, Tricyclic; D008996:Monoamine Oxidase Inhibitors; D005473:Fluoxetine; D016651:Lithium Carbonate; D008094:Lithium