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Systematic Approach to Treatment-Resistant Depression: Psychopharmacology and Psychotherapy 

Systematic Approach to Treatment-Resistant Depression: Psychopharmacology and Psychotherapy
Chapter:
Systematic Approach to Treatment-Resistant Depression: Psychopharmacology and Psychotherapy
Author(s):

K. Ryan Connolly

and Michael E. Thase

DOI:
10.1093/med/9780199739981.003.0002
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date: 24 November 2017

Despite the significant advances in the treatment of major depressive disorder (MDD) over the past 50 years, up to two-thirds of patients remain without a remission of symptoms after first-line treatment. Given the scope and impact of MDD, patients with treatment-resistant depression (TRD) represent a significant portion of depressed patients and require a systematic and aggressive approach to achieve remission of symptoms and return to function. In this chapter, we review the approach to diagnosis and staging of TRD, as well as the goals of treatment. In order to achieve remission of symptoms and return to function, a number of strategies, including medication switch, antidepressant augmentation, combination therapy and the addition of psychotherapy have been proposed; we review and compare the evidence supporting each of these options to provide a systematic approach to the patient with TRD.

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