The need for clinically relevant research on treatment-resistant depression.

Posternak and Zimmerman reported on a series of 74 outpatients with depressive disorders who were treated in their group practice at the Rhode Island Hospital between 1996 and 1999. All of the patients had either failed to respond to or relapsed after responding to an adequate trial of antidepressant medication. The treating psychiatrists either switched the patients to another antidepressant (N = 38) or added a second medication to augment the first antidepressant (N = 36). The relatively even number of patients treated with each strategy was not by design. Rather, it may be viewed as a behavioral indicator of the psychiatrists’ belief that augmenting and switching strategies are comparably useful for antidepressant nonresponders. Forty-five patients (61%) were taking a selective serotonin reuptake inhibitor (SSRI) at the time of the decision to switch or augment. Fifteen patients were taking other newer antidepressants (bupropion, N = 5; venlafaxine, N = 5; nefazodone, N = 4; and mirtazapine, N = 1). Among the remainder, 12 patients were treated with tricyclic antidepressants (TCAs), and 2 patients were taking monoamine oxidase inhibitors (MAOIs) (phenelzine and moclobemide, 1 each). The selection of antidepressants appears to be representative of contemporary psychiatric practice, although moclobemide is not approved for general use in the United States. The Need for Clinically Relevant Research on Treatment-Resistant Depression