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Comment & Response
July 2017

Defining Treatment-Resistant Depression—Reply

Author Affiliations
  • 1Washington University School of Medicine, St Louis, Missouri
  • 2Medical University of South Carolina, Charleston
  • 3Ralph H. Johnson VA Medical Center, Charleston, South Carolina
  • 4Columbia University, New York, New York
JAMA Psychiatry. 2017;74(7):759. doi:10.1001/jamapsychiatry.2017.0970

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.

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