title: Identifying difficult-to-treat depression: differential diagnosis, subtypes, and comorbidities.
abstract: Treatment-resistant depression (TRD) is a common clinical presentation responsible for much of the burden of major depressive disorder worldwide. For this reason, TRD requires aggressive identification and management. Although several models have been proposed to describe TRD, consensus is still needed on the criteria (ie, dose, duration, compliance, number of trials required) used to define treatment response and resistance. When diagnosing patients with depression, clinicians should identify risk factors associated with treatment resistance, including clinical subtypes of depression and medical or psychiatric comorbidities that could affect the course of treatment. When evaluating a patient who has not responded to a first course of antidepressant treatment, the clinician should verify the primary diagnosis and ensure that the patient has adhered to a treatment regimen that was of adequate dose and duration.
authors.affiliation: Department of Psychiatry and UNC Regional Center for STAR*D, University of North Carolina School of Medicine, Chapel Hill, NC 27514, USA. bradley_gaynes@med.unc.edu
authors.forename: Bradley N
authors.initials: BN
authors.lastname: Gaynes
mesh_terms: D000928:Antidepressive Agents / Q000627:therapeutic use*; D015897:Comorbidity; D003866:Depressive Disorder / Q000175:diagnosis / Q000188:drug therapy* / Q000453:epidemiology; D003865:Major Depressive Disorder / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology; D003937:Diagnosis, Differential; D004305:Dose-Response Relationship, Drug; D004334:Drug Administration Schedule; D004351:Drug Resistance; D006801:Humans; D001523:Mental Disorders / Q000175:diagnosis / Q000453:epidemiology; D016032:Randomized Controlled Trials as Topic / Q000706:statistics & numerical data; D012307:Risk Factors; D016896:Treatment Outcome
chemical_list: D000928:Antidepressive Agents