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January 2017

Toward an Evidence-Based, Operational Definition of Treatment-Resistant Depression: When Enough Is Enough

Author Affiliations
  • 1Washington University School of Medicine, St Louis, Missouri
  • 2John Cochran Veterans Affairs Medical Center, St Louis, Missouri
  • 3Medical University of South Carolina, Charleston
  • 4Ralph H. Johnson Veterans Affairs Medical Center, Charleston, South Carolina
  • 5Columbia University, New York, New York
JAMA Psychiatry. 2017;74(1):9-10. doi:10.1001/jamapsychiatry.2016.2586

While perusing posters at a recent international psychiatry conference, a prominent subject garnering intensive interest was the understanding and treatment of treatment-resistant depression (TRD). The definition of TRD, however, was notably vague: ranging from 1 to as many as 8 failed antidepressant treatment trials. This lack of a consensual TRD definition creates enormous problems: it limits the ability to do comparative treatment research, to understand the biological underpinnings of TRD, and produces ambiguous medical insurance coverage issues. This disparity in defining TRD begs the question: When does major depressive disorder (MDD) become resistant?

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