Talk:Treatment-resistant depression

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Electroconvulsive therapy is actually has more potential for collateral damage than Vagus Nerve Stimulation. It can lead to permanent brain damage (mostly memory related). Vagus Nerve Stimulation is only invasive in that it involves a foreign object being implanted in the body.

This is true. I have changed the article to say "more invasive" procedures such as vagus nerve, rather than "more extreme." ECT is about as extreme as it gets as far as therapy goes. I have also added transcranial magnetic stimulation, which is invasive in neither of the ways that these other two treatments are and actually seems to be one of the best options at the moment for those who are looking into these types of treatments.--Gloriamarie 18:13, 11 September 2007 (UTC)

Proposal to rename this Treatment-resistant depression

I always called it thus and this is what I have most commonly seen it referred to in literature as. Input? Happy with rename? Cheers, Casliber (talk · contribs) 02:26, 31 July 2008 (UTC)

• Support rename. TRD outgoogles RD (134,000 vs 55,000). Also easier to understand for laypeople. JFW | T@lk 05:52, 31 July 2008 (UTC)

• You're a psychiatrist, Casliber? Please be bold. ;-) Axl (talk) 15:05, 31 July 2008 (UTC)

• We..ell, yeah, but I must keep on my wikihalo..heck it's nearly 1 am here (Sydney)...I'll give it till tomorrow after a sleep...Cheers, Casliber (talk · contribs) 15:16, 31 July 2008 (UTC)

Stupid term

Yes, it's a more common term than refractory depression in the literature, but it's also a term created by aping medical descriptions such as "extensively drug-resistant tuberculosis". However, there's no pathogen so it's effectively ascribing it to a fault in the patient. To be honest (although not acknowledged), a far better title would "psychiatrists without a clue wasting people's time with quack treatments" syndrome. --79.75.13.219 (talk) 16:35, 15 October 2008 (UTC)

What is the point of your comment? Its not helpful and very insulting. I'm suffering from treatment resistant depression myself and as far as this article is concerned it could use a lot more information. It blows my mind that in the 4 years I've been frequenting Wikipedia no psychiatrists have taken the time to add more substance to this article. Mramz88 (talk) 09:22, 5 August 2010 (UTC)

Student edits to begin

Greta Munger (talk) 14:51, 17 April 2014 (UTC)

References

Andrews, L. W. (2010). Encyclopedia of depression. Santa Barbara, Calif: Greenwood Press.

Carvalho, A. F., Cavalcante, J. L., Castelo, M. S., & Lima, M. C. (2007). Augmentation strategies for treatment-resistant depression: A literature review. Journal of Clinical Pharmacy and Therapeutics, 32(5), 415-428. doi:10.1111/j.1365-2710.2007.00846.x

Dougherty, D. (2013). This issue: Deep brain stimulation. Psychiatric Annals, 43(8), 348-349.

Fekadu, A., Wooderson, S. C., Markopoulo, K., Donaldson, C., Papadopoulos, A., & Cleare, A. J. (2009). What happens to patients with treatment-resistant depression? A systematic review of medium to long term outcome studies. Journal of Affective Disorders, 116, 4-11. doi:10.1016/j.jad.2008.10.014

Fink, M. (2009). Electroconvulsive therapy: A guide for professionals and their patients. Oxford: Oxford University Press.

Friedman, E. S., & Anderson, I. M. (2011). Managing depression in clinical practice. London: Springer.

Kasper, S., & Montgomery, S. A. (2013). Treatment-resistant depression. Somerset, NJ: Wiley.

Kornstein, S., & Schneider, R. K. (2001). Clinical features of treatment-resistant depression. Journal of Clinical Psychiatry, 62, 18-25.

Nierenberg, A., & White, K. (1990). What next? A review of pharmacologic strategies for treatment resistant depression. Psychopharmacology Bulletin, 26(4), 429-460.

Papakostas, G. I., & Fava, M. (2010). Pharmacotherapy for depression and treatment-resistant depression. Hackensack, NJ: World Scientific.

Rogers, M. H., & Anderson, P. B. (2009). Deep brain stimulation: Applications, complications and side effects. New York: Nova Biomedical Books.

Scott, J. (1994). Predictors of non-response to antidepressants. In Nolen, W. (Ed.); Zohar, J. (Ed.); Roose, S., P. (Ed.); Amsterdam, J., D. (Ed.) depression: Current strategies and future directions (pp. 19-24). Oxford, England: John Wiley & Sons.

Souery, D., Oswald, P., Massat, I., Bailer, U., Bollen, J., Demyttenaere, K., . . . Mendlewicz, J. (2007). Clinical Factors Associated With Treatment Resistance in Major Depressive Disorder: Results From a European Multicenter Study. Journal of Clinical Psychiatry, 68(7), 1062-1070. doi:10.4088/JCP.v68n0713

Trivedi, R. B., Nieuwsma, J. A., & Williams, J. W. (2011). Examination of the Utility of Psychotherapy for Patients with Treatment Resistant Depression: A Systematic Review. Journal of General Internal Medicine, 26(6), 643-650. doi:10.1007/s11606-010-1608-2

Trivedi, R., Nieuwsma, J. A., Williams, J. W., & Baker, D. (2009). Evidence synthesis for determining the efficacy of psychotherapy for treatment resistant depression. Washington, DC: Dept. of Veterans Affairs, Health Services Research & Development Service.

21:50, 22 April 2014 (UTC)Katie Lloyd (talk) 21:52, 22 April 2014 (UTC)

Sources look good. Not clear at this point how you are going to organize it, but definitely think about sub-sections and the order you present information. Put the most general definition first, then various aspects.

• Organization: remember that people hop around in reading Wikipedia articles, so make each little section as independent as you can
• Methods: what kind of research supports these theories? Some sections will need more method details than others, helpful to keep in mind these descriptions: 3 research methods (experiments vs correlation vs descriptive); 2 data-collection (self-report vs observation); 2 research settings (lab vs field)
• Figures and tables: be thoughtful. Wikicommons has lots of pictures that might be useful. You cannot copy directly from journal articles (copyright violation), but you can recreate a figure and then donate it yourself. Greta Munger (talk) 12:34, 23 April 2014 (UTC)

• Post on the talk how you want to organize your information.
• Perhaps you can edit the current summary of the topic then add sub-headings for causes, alternate treatments, current research, etc.
• It might be interesting to include a 'controversial treatment' sub-heading where you can elaborate on early methods of electroconvulsive therapy (I see you already have an article about that).
• Might be interesting to also include a 'culture' sub-heading and include any research you can find on the connection between culture treatment-resistant depression. Are there certain cultures that are more resistant to depression treatments?
• Is there a biological reason as to why some people are resistant to treatment?
• Try to link the research from your articles to information from a textbook as well.

Ayahmed17 (talk) 12:15, 25 April 2014 (UTC)

This is an Encyclopedia

We don't need government-sponsored paternalistic tripe about how drug abuse can be involved with stimulants here - what is the point of adding it...? it is self-evident (we already make things emphatically clear by pointing out no one who is addictively-prone or cardiologically-unsound should consider this possibility, like good Boy Scouts...) The propaganda-flavored moralism (moralism is ethics in its lowest state) is also insulting and marginalizing to those individuals who actually benefit from psychostimulant medicines after all else has failed them... My mother has Multiple Sclerosis, folks, with co-morbid MDD, the brain stimulation did NOTHING! Life without stimulants would be like living death for her - so let's make such people feel even worse, right? GEEZ. Yeah, let's make them feel more miserable as if pathological demonized automatic born criminals in need of DEA stormtroop guardianship because NECESSARILY unethical (right?) as what is a poison to others, is a boon to some...

PARACELSUS: ALL IS A TOXIN: DOSE DETERMINES THE POISONOUSNESS — Preceding unsigned comment added by 2602:304:B34B:A940:F051:AB0F:3A76:DE48 (talk) 18:39, 18 June 2015 (UTC)

Treatment-Resistant Depression ≠ Pseudo-Resistance to depression.

Pseudoresistant depression is distinct from Treatment-Resistant Depression (TRD). People with TRD are diagnosed as such because they aren't responding adequately to accepted treatments and modalities. Pseudoresistance to depression is, as it sounds, "pseudo" meaning what presents as "resistance" is actually inadequate treatment. The second sentence explains this and thus contradicts the preceding sentence. To summarize: not responding adequately to treatment and receiving inadequate treatment are not the same thing and presenting them as occasionally synonymous confuses the topic by implying that people with TRD are merely receiving inadequate treatment and aren't resistant to treatment at all. Therefore, I do not think the following references to "Pseudoresistant Depression" (PRD) in the opening paragraph should be in this article at all and would be more appropriate on a page about PRD specifically.

People with treatment-resistant depression who do not adequately respond to antidepressant treatment are sometimes referred to as pseudoresistant. (3) Some factors that contribute to inadequate treatment are: early discontinuation of treatment, insufficient dosage of medication, patient noncompliance, misdiagnosis, and concurrent psychiatric disorders.(3)

(3) Treatment-resistant depression - PubMed (nih.gov) - sourced from the abstract of a paper, it is merely the opinion of the author that TRD is usually someone's fault. Belial Lovett (talk) 21:15, 18 October 2022 (UTC)

I agree. I removed that sentence (diff), in part because most readers would not understand its meaning, but most importantly because the "pseudo" term is not prominent in the literature on this topic. Mark D Worthen PsyD (talk) [he/him] 19:12, 11 December 2022 (UTC)

Very interesting research; thus far no secondary sources

Not yet fit for inclusion, but this research is very interesting: BH4 deficiency and cerebral folate deficiency found in some patients with TRD in a replication study by Lisa Pan et al: PMID 36330595. Cheers, --CopperKettle (talk) 05:21, 9 December 2022 (UTC)

I agree that's fascinating research and consistent with the modest efficacy of treatment augmentation with L-methylfolate (levomefolic acid). Mark D Worthen PsyD (talk) [he/him] 19:25, 11 December 2022 (UTC)

Lead section improvements

In this edit (diff), I changed a sentence from: "Inadequate response has traditionally been defined as no clinical response whatsoever (e.g. no improvement in depressive symptoms). However, many clinicians consider a response inadequate if the person does not achieve full remission of symptoms" to: "Inadequate response has most commonly been defined as less than 50% reduction in depressive symptoms following treatment with at least one antidepressant medication, although definitions vary widely." The previous sentence lacked a page number in the 2010 reference, and is not valid when reads contemporary reliable sources such as the now-cited 2022 reference. Mark D Worthen PsyD (talk) [he/him] 19:31, 11 December 2022 (UTC)

More edits (diff), explained in the edit summaries. I used one reliable source twice in the lead section, which is not ideal, so additional reliable sources should be added as we can. The epidemiological section lacked a reference. It's an important section when we can develop it. // Note that psychiatric disorders are medical disorders. If we write something like, "medical conditions and psychiatric disorders" we perpetuate mind-body dualism. // Keep in mind that "treatment-resistant depression" is not a condition, or stated a bit differently, it is not a depression subtype. Mark D Worthen PsyD (talk) [he/him] 20:12, 11 December 2022 (UTC)