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Journal of Psychopharmacology, Vol. 6, No. 2, 167-171 (1992)
DOI: 10.1177/026988119200600208

Treatment-resistant depression: additional perspectives

Martin H. Rosenzweig

Depression Research Unit, Department of Psychiatry, University of Pennsylvania School of Medicine, Philadelphia, PA 19104, USA

Jay D. Amsterdam

Depression Research Unit, Department of Psychiatry, University of Pennsylvania School of Medicine, Philadelphia, PA 19104, USA

Treatment-resistant depression (TRD) is usually thought to characterize -10-15% of patients who are refractory to all conventional antidepressant therapy. However, in its broadest definition, TRD occurs across a spectrum of severity and is not an uncommon clinical problem, defining a sizeable portion of patients with mood disorders. Although the majority of treatment outcome studies report response rates to antidepressants in the 60-70% range, this figure should not be viewed as indicating the rate of remission, but rather an estimate of improvement from minimal response to complete remission. Thus, while as many as 60% of depressed patients may have some degree of response to antidepressant treatment, only ~ 25-30% of patients will achieve clinical remission. Therefore, estimates of response rate can hide the fact that most patients who are described as 'improved' with pharmacotherapy actually have a form of partial TRD. In this framework, a more realistic view of the TRD syndrome should encompass a broad spectrum of cases ranging from partial to complete drug resistance. It is in this context that we view this timely review on TRD by Malizia and Bridges.

Key Words: affective disorders • treatment-resistant • depressive subtypes • Commentary


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