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We all know what we mean by treatment-resistant depression – don't we?

  • Ian M. Anderson (a1)
Summary

Although in common use, treatment-resistant depression is unhelpful both conceptually and practically. In this issue a new term, multiple-therapy-resistant major depressive disorder, is proposed; although it may be useful in guiding treatment options for patients with persisting depression, it should not be an automatic trigger for further, more invasive treatments.

Declaration of interests

I.M.A. has been a consultant for pharmaceutical companies developing and marketing antidepressants and has been an author on publications that have used the term treatment-resistant depression.

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Copyright
Corresponding author
Correspondence: Ian M. Anderson, Neuroscience and Psychiatry Unit, Division of Neuroscience and Experimental Psychology, University of Manchester and Manchester Academic Health Science Centre, Room G809, Stopford Building, Oxford Road, Manchester M13 9PT, UK. Email: ian.anderson@manchester.ac.uk
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See pp. 274–278, this issue.

Footnotes
References
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1.Cleare, A, Pariante, CM, Young, AH, Anderson, IM, Christmas, D, Cowen, PJ, et al. Evidence-based guidelines for treating depressive disorders with antidepressants: a revision of the 2008 British Association for Psychopharmacology guidelines. J Psychopharmacol 2015; 29: 459–25.
2.National Institute for Health and Care Excellence. Clinical Guideline 90. Depression in Adults: Recognition and Management.NICE, 2009 (https://www.nice.org.uk/guidance/cg90/resources/depression-in-adults-recognition-and-management-pdf-975742636741).
3.McAllister-Williams, RH, Christmas, DMB, Cleare, AJ, Currie, A, Gledhill, J, Insole, L, et al. Multiple-therapy-resistant-major depressive disorder: a clinically important concept. Br J Psychiatry 2018; 212: 274278.
4.Berlim, MT, Turecki, G. Definition, assessment, and staging of treatment-resistant refractory major depression: a review of current concepts and methods. Can J Psychiatry 2007; 52: 4654.
5.Zhou, X, Ravindran, AV, Qin, B, Del, GC, Li, Q, Bauer, M, et al. Comparative efficacy, acceptability, and tolerability of augmentation agents in treatment-resistant depression: systematic review and network meta-analysis. J Clin Psychiatry 2015; 76: e48798.
6.Schosser, A, Serretti, A, Souery, D, Mendlewicz, J, Zohar, J, Montgomery, S, et al. European Group for the Study of Resistant Depression (GSRD)--where have we gone so far: review of clinical and genetic findings. Eur Neuropsychopharmacol 2012; 22: 453–68.
7.Conway, CR, George, MS, Sackeim, HA. Toward an evidence-based, operational definition of treatment-resistant depression: when enough is enough. JAMA Psychiatry 2017; 74: 910.
8.Ruhe, HG, van, RG, Spijker, J, Peeters, FP, Schene, AH. Staging methods for treatment resistant depression. A systematic review. J Affect Disord 2012; 137: 3545.
9.Kirsch, I, Deacon, BJ, Huedo-Medina, TB, Scoboria, A, Moore, TJ, Johnson, BT. Initial severity and antidepressant benefits: a meta-analysis of data submitted to the food and drug administration. PLoS Med 2008; 5: e45.
10.Turner, EH, Matthews, AM, Linardatos, E, Tell, RA, Rosenthal, R. Selective publication of antidepressant trials and its influence on apparent efficacy. N Engl J Med 2008; 358: 252–60.
11.Furukawa, TA, Weitz, ES, Tanaka, S, Hollon, SD, Hofmann, SG, Andersson, G, et al. Initial severity of depression and efficacy of cognitive-behavioural therapy: individual-participant data meta-analysis of pill-placebo-controlled trials. Br J Psychiatry 2017; 210: 190–6.
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The British Journal of Psychiatry
  • ISSN: 0007-1250
  • EISSN: 1472-1465
  • URL: /core/journals/the-british-journal-of-psychiatry
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We all know what we mean by treatment-resistant depression – don't we?

  • Ian M. Anderson (a1)
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