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Depression, Treatment Resistant

Michelle Magid, MBA, MD Reviewed 06/2022
 


BASICS

DESCRIPTION

  • Major depressive disorder (MDD) that has failed to respond to ≥2 adequate trials of antidepressant therapy in ≥2 different classes is considered to be "Treatment Resistant".

  • Individua...

DIAGNOSIS

HISTORY

  • Symptoms are the same as in MDD. However, patients do not respond to standard form of treatment.

  • Important to screen for suicidality in treatment-resistant depression

  • Screening with SIG...

TREATMENT

MEDICATION

First Line

Please see “Depression” topic. When those fail, augmentation and combination strategies are as follows: 
  • Antidepressants in combination

ONGOING CARE

FOLLOW-UP RECOMMENDATIONS

  • Frequent visits (i.e., every month)

  • During follow-up, evaluate side effects, dosage, and effectiveness of medication as well as need for referral to ECT or Ketamin...

REFERENCES

1
McIntyre  RS, Filteau  MJ, Martin  L, et al. Treatment-resistant depression: definitions, review of the evidence, and algorithmic approach. J Affect Disord.  2...

CODES

ICD10

  • F32.9 Major depressive disorder, single episode, unspecified

  • F33.9 Major depressive disorder, recurrent, unspecified

SNOMED

  • 35489007 Depressive disorder (disorder)

  • 66344007 Recurrent major depr...

CLINICAL PEARLS

  • Treatment-resistant depression is common, affecting 1/3 of those with MDD.

  • Combination and augmentation strategies with antidepressants, antipsychotics, therapy, and mood stabilizers ca...

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