Treatment-resistant depression

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Treatment-resistant depression
Classification and external resources
MeSH D061218

Treatment-resistant depression (TRD) or treatment-refractory depression is a term used in clinical psychiatry to describe cases of major depressive disorder that do not respond to adequate courses of at least two antidepressants.[1]

The term was first coined with the development of the concept in 1974. Treatment of refractory depression traditionally involved electroconvulsive therapy and use of non-standard medications, but new technologies such as transcranial magnetic stimulation are being studied as a safer alternative. Treatment of refractory depression may also involve more invasive interventions such as vagus nerve stimulation.

In treatment-resistant depression, some text books recommend the addition of low dose lithium or low dose thyroxine. Since the entry of olanzapine into psychopharmacology, many[quantify] psychiatrists have been adding low dose olanzapine to antidepressants and other atypical antipsychotics such as aripiprazole and quetiapine. These have shown promise in treating refractory depression but come with serious side effects. MAOIs are considered very effective for certain types of refractory depression.[2]

Stimulants such as amphetamines and methylphenidate have also been tested with positive results but have a high potential for abuse. However, stimulants have been shown to be effective for the unyielding depressed combined lacking addictive personality traits or heart problems.[3][4][5]


  1. ^ Wijeratne, Chanaka; Sachdev, Perminder (2008). "Treatment-resistant depression: critique of current approaches". The Australian and New Zealand journal of psychiatry 42 (9): 751–62. doi:10.1080/00048670802277206. PMID 18696279. 
  2. ^ Stead, Latha G.; Stead, S. Matthew; Kaufman, Matthew S.; Melin, Gabrielle J. (2005). First aid for the psychiatry clerkship: a student-to-student guide. New York: McGraw-Hill. p. 140. ISBN 978-0-07-144872-7. 
  3. ^ Parker, G; Brotchie, H (2010). "Do the old psychostimulant drugs have a role in managing treatment-resistant depression?". Acta Psychiatrica Scandinavica 121 (4): 308–14. doi:10.1111/j.1600-0447.2009.01434.x. PMID 19594481. 
  4. ^ Satel, SL; Nelson, JC (1989). "Stimulants in the treatment of depression: a critical overview". The Journal of clinical psychiatry 50 (7): 241–9. PMID 2567730. 
  5. ^