Treatment Resistant Depression — A Collective Failure of Imagination

“Unfortunately, there is another major problem with research on TRD: the almost complete absence of psychological treatments. In one systematic overview, a total of 148 different definitions of TRD were collected from the literature. All definitions included at least one failed treatment with antidepressants, but only six definitions (4%) included one failed treatment with psychotherapy. This is remarkable…”

Pim Cuijpers2023, World Psychiatry

This article by Dr. Awais Aftab has been published on the Psychiatry at the Margins website. It begins:

“The concept of ‘treatment-resistant depression’ (TRD), as we currently understand and use the term, reflects a highly parochial mindset. The assumptions embedded in the concept point towards a clinical world in which initial treatment with antidepressants is the norm and further pharmacological treatment is the default option; other treatment modalities, especially psychotherapy, are an afterthought; diagnostic heterogeneity runs rampant; symptom clusters are poorly validated; and no one quite knows how to prioritize treatment of comorbid diagnoses. It is only in such a world that it even becomes reasonable to think, ‘Oh no, this patient has failed to respond to two trials of antidepressants! They must have some exceptional form of depression. What do we do now?!’ A clinical state of affairs centered around the concept of TRD is an impoverished one, where clinicians are expected to follow treatment algorithms on autopilot, with minimal self-reflection and a lack of awareness of the contradictions that sustain this model of care …”

You can read more from here.

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