Cited by 412Treatment of Major DepressionElectroconvulsive Therapy StudiesAnxiety, Depression, Psychometrics, Treatment, Cognitive Processes

Definition, Assessment, and Staging of Treatment—Resistant Refractory Major Depression: A Review of Current Concepts and Methods

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Berlim, Marcelo T, Turecki, Gustavo·2007·The Canadian Journal of Psychiatry

Abstract

Objective Up to 15% of depression patients eventually present with treatment-resistant or refractory depression (TRD), a condition that causes significant social and economic burdens. Our paper aims to summarize the current medical literature on the conceptual and methodologic issues involved in the definition, assessment, and staging of TRD. Method We reviewed the recently published medical literature to identify papers that specifically discuss TRD. For this, we searched MEDLINE, EMBASE, and PsycINFO for potentially relevant English-language articles published between January 1996 and June 2006. Results Recent methodologic and conceptual advances have contributed to the achievement of an acceptable level of theoretical consensus on the general meaning of TRD. Accordingly, depression is usually considered resistant or refractory when at least 2 trials with antidepressants from different pharmacologic classes (adequate in terms of dosage, duration, and compliance) fail to produce a significant clinical improvement. Regarding diagnostic assessments, an accurate and systematic evaluation should be made to elicit the potential role of several contributing factors, such as medical and psychiatric comorbidity. Conclusion Recently, 3 staging methods for TRD have been described, but they currently require extensive empirical support. Future research on TRD should include prospective studies addressing the validity of the proposed criteria, the impact of depression comorbid with othe…

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Crossref · 10.1177/070674370705200108

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Authors
Berlim, M. T., & Turecki, G.
Affiliations
Douglas Mental Health University Institute (CA)
Venue
The Canadian Journal of Psychiatry
Published
2007-01
Volume
52
Issue
1
Pages
46-54
ISSN
  • 0706-7437 (ISSN-L)
  • 1497-0015
OpenAlex
W57359236
Cited by
412
References
4
Citations by year
2026: 23 · 2025: 17 · 2024: 22 · 2023: 22 · 2022: 37 · 2021: 30 · 2020: 21 · 2019: 28 · 2018: 20 · 2017: 16 · 2016: 21 · 2015: 23 · 2014: 23 · 2013: 31 · 2012: 18
FWCI
1.43
Type
journal article
Language
en
Open access
Locations
  • The Canadian Journal of Psychiatry (publishedVersion)
  • PubMed (publishedVersion)
Topics
  • Health Sciences › Medicine › Pharmacology › Treatment of Major Depression
  • Health Sciences › Medicine › Psychiatry and Mental health › Electroconvulsive Therapy Studies
  • Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
Keywords
treatment-resistant depression, antidepressant trials, comorbidities, psychiatric comorbidity, predictors of treatment outcome
MeSH terms
Antidepressive Agents, Tricyclic, Major Depressive Disorder, Dose-Response Relationship, Drug, Drug Resistance, Humans, Imipramine, Patient Compliance, Personality Disorders, Severity of Illness Index, Time Factors, Comorbidity, Prevalence, Randomized Controlled Trials as Topic, Substance-Related Disorders

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