Treatment-resistant Depression
Scott Aaronson, M.D.
What is treatment-resistant depression?
There isn't a standard definition for treatment-resistant depression. I would
define it as a depression that has failed to respond to an adequate dose of
an approved psychiatric agent given for at least four to six weeks. However,
I wouldn't consider a patient to be treatment resistant until the patient
has failed to see results on at least two to three different medications.
It is important to remember that 35% of patients do not respond to initial
treatment. So if you haven't experienced any results with one medication,
this does not necessarily mean you are treatment resistant. In general, if
you fail to see any improvements on an adequate dosage for four weeks, then
the particular medication is not working and it is time to try a new medication.
Who typically has treatment resistant depression?
Almost everyone has a chance of becoming treatment resistant. I usually see
patients that have been through several doctors and medications. Often these
patients have developed a dysthymic disorder, (a chronic unhappiness) and
have many physiological and psychological symptoms. They get referred to me
because their doctors have run out of options.
What therapies are available for treatment-resistant
depression?
There are different approaches to try. I can move a patient to a different
class of medication or combine medications. I look for a response to a medication,
and at least a 30% improvement.
What are the success rates?
I would say about 70% of the patients that I see respond to a medication,
but it may be a partial response and not as much as I would like. So it is
important to combine medication with other therapies, such as psychotherapy.
Psychotherapy can help patients change their perceptions of themselves and
world around them.
© 2001 Families for Depression Awareness
