In Reply Fogelson and Leuchter have responded to our proposed staging scheme for treatment-resistant depression (TRD) published in JAMA Psychiatry.1 We do not fundamentally disagree with their arguments; however, we stand by our proposal that psychiatry needs to move toward a more empirically based TRD definition.
Fogelson and Leuchter express concern about the lack of evidence to support using different antidepressant classes to improve antidepressant efficacy. In putting forward our preliminary TRD staging model, we included both psychopharmacology and psychotherapy treatments. Further, we describe preliminary treatment recommendations for stage I TRD, which include nonpharmacological treatments (electroconvulsive therapy and repetitive transcranial magnetic stimulation) as possible treatment trials for stage I TRD.
Charles R. Conway, Mark S. George, Harold A. Sackeim. Defining Treatment-Resistant Depression—Reply. JAMA Psychiatry. 2017;74(7):759. doi:10.1001/jamapsychiatry.2017.0970