title: [Stages of treatment resistance in depressive disorders, defined after somatotherapeutic methods].
abstract: This brief survey is not a systematic review of the literature on treatment-resistant depression (TRD). Rather, in the light of results of controlled clinical trials, proposals for assessment of TRD are made: First-degree treatment resistance implies nonresponse to standard antidepressive therapy (two successive adequate treatments with antidepressants, combined with induced-wakefulness therapy). Second-degree treatment resistance is defined by nonresponse to alternative treatment strategies (MAO inhibitors, lithium augmentation, electroconvulsive therapy, infusion therapy) that have proved to be effective in TRD both in clinical practice and in systematic investigations. In this therapeutic situation, the only option still open is to resort to previously ineffective therapy or to turn (as yet) inadequately established therapeutic strategies. Criteria for third-degree treatment resistance should not be based on nonresponse to specific further therapeutic trials but on the duration of the treatment (at least 2 years).
authors.affiliation: Psychiatrische Universitätsklinik Münster.
authors.forename: H
authors.initials: H
authors.lastname: Kuhs
mesh_terms: D006801:Humans; D000928:Antidepressive Agents / Q000009:adverse effects / Q000627:therapeutic use; D002908:Chronic Disease; D002986:Clinical Trials as Topic; D003131:Combined Modality Therapy; D003866:Depressive Disorder / Q000145:classification / Q000523:psychology / Q000628:therapy; D004565:Electroconvulsive Therapy; D016651:Lithium Carbonate / Q000009:adverse effects / Q000627:therapeutic use; D012892:Sleep Deprivation; D017211:Treatment Failure
chemical_list: D000928:Antidepressive Agents; D016651:Lithium Carbonate
vernacular_title: Stufen in der Behandlungsresistenz bei depressiven Störungen, definiert nach somatotherapeutischen Verfahren.