The role of Axis II comorbidity in the management of patients with treatment-resistant depression.
A significant proportion of antidepressant nonresponders have personality disorders. The relationship between antidepressant resistance and personality pathology is far from straightforward, however, and reflects a disproportionate "burden" of negative prognostic correlates, psychosocial risk factors, and problems that compromise effective therapeutic relationships. An important clinical ground rule is to avoid the reductionistic logical tautology that explains antidepressant failure as a consequence of personality disorder and, by implication, that the patient may deserve to suffer. In evaluating antidepressant-resistant patients, identification of pathologic personality traits or disorders may help provide important clues for future trials of both pharmacotherapy and psychotherapy, particularly in combination.
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Department of Psychiatry, Western Psychiatric Institute and Clinic, University of Pittsburgh School of Medicine, Pennsylvania, USA.
D000928:Antidepressive Agents / Q000627:therapeutic use*; D001290:Attitude; D019090:Case Management; D015928:Cognitive Behavioral Therapy / Q000379:methods; D015897:Comorbidity; D003866:Depressive Disorder / Q000150:complications* / Q000188:drug therapy* / Q000628:therapy; D004351:Drug Resistance; D004565:Electroconvulsive Therapy; D005260:Female; D006801:Humans; D007398:Interpersonal Relations; D008297:Male; D010554:Personality Disorders / Q000145:classification / Q000150:complications / Q000175:diagnosis / Q000628:therapy
D000928:Antidepressive Agents