Skip to main content Accessibility help
×
Home

Treatment-resistant depression: problematic illness or a problem in our approach?

  • Gin S. Malhi (a1), Pritha Das (a2), Zola Mannie (a3) and Lauren Irwin (a4)

Summary

Treatment-resistant depression is widely defined as non-response to two ‘adequate’ courses of treatment. However, the definitions of treatment and depression are inconsistent reflecting gaps in our understanding. We argue that a failure to respond is often the result of administering inappropriate treatment, which occurs principally because of paradigm failure.

Declaration of interest

None.

  • View HTML
    • Send article to Kindle

      To send this article to your Kindle, first ensure no-reply@cambridge.org is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about sending to your Kindle. Find out more about sending to your Kindle.

      Note you can select to send to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be sent to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

      Find out more about the Kindle Personal Document Service.

      Treatment-resistant depression: problematic illness or a problem in our approach?
      Available formats
      ×

      Send article to Dropbox

      To send this article to your Dropbox account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Dropbox.

      Treatment-resistant depression: problematic illness or a problem in our approach?
      Available formats
      ×

      Send article to Google Drive

      To send this article to your Google Drive account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Google Drive.

      Treatment-resistant depression: problematic illness or a problem in our approach?
      Available formats
      ×

Copyright

Corresponding author

Correspondence: Gin S. Malhi, Discipline of Psychiatry, Sydney Medical School, University of Sydney, Sydney, NSW 2065, Australia. Email: gin.malhi@sydney.edu.au

References

Hide All
1Anderson, IM. We all know what we mean by treatment-resistant depression – don't we? Br J Psychiatry 2018; 212: 259–61.
2Malhi, GS, Byrow, Y. Is treatment-resistant depression a useful concept? Evid Based Ment Health 2016; 19: 13.
3McAllister-Williams, R, Christmas, D, Cleare, A, Currie, A, Gledhill, J, Insole, L, et al. Multiple-therapy-resistant major depressive disorder: a clinically important concept. Br J Psychiatry 2018; 212: 274–8.
4Jorm, AF, Patten, SB, Brugha, TS, Mojtabai, R. Has increased provision of treatment reduced the prevalence of common mental disorders? Review of the evidence from four countries. World Psychiatry 2017; 16: 90–9.
5Ruggero, CJ, Carlson, GA, Kotov, R, Bromet, EJ. Ten-year diagnostic consistency of bipolar disorder in a first-admission sample. Bipolar disorders 2010; 12: 2131.
6Silberman, EK, Weiss, KJ. Treatment-resistant depression or misdiagnosed anxiety disorder? J Nerv Ment Dis 2016; 204: 67.
7Bassett, D, Mulder, R, Outhred, T, Hamilton, A, Morris, G, Das, P, et al. Defining disorders with permeable borders: you say bipolar. I say borderline! Bipolar Disord 2017; 19: 320–3.
8American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, 5th edn (DSM-5). APA, 2013.
9World Health Organization. The ICD-10 Classification of Mental and Behavioural Disorders: Clinical Descriptions and Diagnostic Guidelines. World Health Organization, 1992.
10Malhi, GS, Berk, M, Morris, G, Hamilton, A, Outhred, T, Das, P, et al. Mixed mood: the not so united states? Bipolar Disord 2017; 19: 242–5.
11Faedda, GL, Marangoni, C. What is the role of conventional antidepressants in the treatment of major depressive episodes with Mixed Features Specifier? CNS Spectr 2017; 22: 120–5.
12Ghaemi, SN. Why antidepressants are not antidepressants: STEP-BD, STAR* D, and the return of neurotic depression. Bipolar Disord 2008; 10: 957–68.
13Rush, AJ, Trivedi, MH, Wisniewski, SR, Nierenberg, AA, Stewart, JW, Warden, D, et al. Acute and longer-term outcomes in depressed outpatients requiring one or several treatment steps: a STAR* D report. Focus 2008; 6: 128–42.
14Sachs, GS, Nierenberg, AA, Calabrese, JR, Marangell, LB, Wisniewski, SR, Gyulai, L, et al. Effectiveness of adjunctive antidepressant treatment for bipolar depression. N Engl J Med 2007; 356: 1711–22.
15Bauer, M, El-Khalili, N, Datto, C, Szamosi, J, Eriksson, H. A pooled analysis of two randomised, placebo-controlled studies of extended release quetiapine fumarate adjunctive to antidepressant therapy in patients with major depressive disorder. J Affect Disord 2010; 127: 1930.
16Ghaemi, SN. Toward a Hippocratic psychopharmacology. Can J Psychiatry 2008; 53: 189–96.

Keywords

Metrics

Altmetric attention score

Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed

Treatment-resistant depression: problematic illness or a problem in our approach?

  • Gin S. Malhi (a1), Pritha Das (a2), Zola Mannie (a3) and Lauren Irwin (a4)
Submit a response

eLetters

No eLetters have been published for this article.

×

Reply to: Submit a response


Your details


Conflicting interests

Do you have any conflicting interests? *