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Treatment-resistant depression (TRD) is a term used in clinical psychiatry to describe cases of major depressive disorder (MDD) that do not respond adequately to appropriate courses of at least two antidepressants.

Definition

The term "treatment-resistant depression" is generally applied to patients who fail to respond to at least two different trials of antidepressants from different pharmacologic classes, each used for a sufficient duration and at a therapeutic dose. It is important to rule out pseudo-resistance, which can be caused by factors such as noncompliance, inadequate dosing, and substance abuse.

Epidemiology

Treatment-resistant depression is relatively common; estimates suggest that around 30% of patients with MDD could be classified as treatment-resistant. The likelihood of treatment resistance increases with the number of previous depressive episodes.

Treatment

Treatment options for TRD include switching to a different antidepressant, augmentation with a second medication, and psychotherapy. More invasive treatments such as electroconvulsive therapy (ECT) and deep brain stimulation (DBS) may be considered in severe cases.

Switching Antidepressants

If a patient does not respond to an antidepressant, a different antidepressant can be tried. This can involve switching within the same class of drugs or to a different class.

Augmentation

Augmentation strategies involve the addition of a second drug to an existing antidepressant. The second drug is often from a different pharmacologic class. Commonly used augmenting agents include lithium and atypical antipsychotics.

Psychotherapy

Psychotherapy, including cognitive-behavioral therapy (CBT) and interpersonal therapy (IPT), can be effective in treating TRD, particularly in patients with psychosocial stressors or interpersonal difficulties.

Invasive Treatments

In severe cases of TRD where other treatments have failed, more invasive procedures such as ECT or DBS may be considered. These treatments can be effective but also carry risks and are generally reserved for the most severe cases.

See Also

• Major depressive disorder
• Antidepressant
• Psychotherapy
• Electroconvulsive therapy
• Deep brain stimulation

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