Display Settings:

Format

Send to:

Choose Destination
See comment in PubMed Commons below
Am J Psychiatry. 1991 Jun;148(6):695-704.

The clinical meaning of refractory depression: a review for the clinician.

Author information

  • 1Affective Disorders Program, Hamilton Psychiatric Hospital, Ontario, Canada.

Abstract

OBJECTIVE:

The authors' goal is to address the complex issue of treatment-refractory depression from a clinical perspective.

DATA COLLECTION:

They review the literature on the major clinical and methodological issues involved in the treatment and study of treatment-refractory depression as well as primary and tertiary care surveys of patients whose depression has not responded to treatment.

FINDINGS:

There are methodological problems in defining treatment-refractory depression and in the tertiary care surveys of treatment-refractory depression. The authors define treatment-refractory depression as primarily involving diagnostic-treatment variables rather than patient variables. They articulate these variable as a series of questions the clinician may consider when confronted with patients who are considered refractory: 1) Is the diagnosis correct? 2) Has the patient received adequate treatment? 3) Was a rational stepped-care approach used? 4) How was outcome measured? 5) Is there a coexisting medical or psychiatric disorder that interferes with response to treatment? and 6) Are there factors in the clinical setting that are interfering with treatment?

CONCLUSIONS:

The problem of treatment-refractory depression has to do primarily with the diagnostic-treatment process than with patient variables. This has a number of implications in the areas of training, education, research, and public health. The evidence indicates that improvements in the recognition and treatment of depression are needed.

Comment in

PMID:
2035712
[PubMed - indexed for MEDLINE]
PubMed Commons home

PubMed Commons

0 comments
How to join PubMed Commons

    Supplemental Content

    Full text links

    Icon for Silverchair Information Systems
    Loading ...
    Write to the Help Desk