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Psychiatr Clin North Am. 2018 Jun;41(2):249-261. doi: 10.1016/j.psc.2018.01.003. Epub 2018 Mar 21.

Treatment-Resistant Depression: The Importance of Identifying and Treating Co-occurring Personality Disorders.

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Sheppard Pratt Health System, 6501 North Charles Street, Towson, MD 21204, USA. Electronic address:


Treatment-resistant depression (TRD) presents a significant burden to individuals and society, and comprehensive, individualized approaches are needed to address this complex clinical situation. Diagnostic reevaluation is indicated in cases of TRD to determine the numerous factors that could be playing a role in the treatment resistance. Factors to assess during the diagnostic reevaluation are discussed, including assessment for personality disorders, which are common contributors to treatment resistance and are often not adequately addressed. Two case studies are presented to illustrate the importance of addressing underlying personality disorders in the setting of chronic depression and TRD.


Borderline personality disorder; Depression; Personality disorder; Personality traits; Treatment-resistant depression

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