Fast Five Quiz: Treatment-Resistant Depression

Ravinder N. Bhalla, MD


August 19, 2021

Pseudoresistance can complicate the diagnosis of TRD. Pseudoresistance may occur in patients who were prescribed suboptimal doses of antidepressants or discontinued medication early for such reasons as intolerable side effects, nonadherence, or underdosing.

Neuroimaging may be useful to illuminate the nature of a neurologic illness that may produce psychiatric symptoms, but these studies are costly and may be of dubious value in patients without distinct neurologic deficits. CT or MRI of the brain should be considered if organic brain syndrome or hypopituitarism is included in the differential diagnosis. Similarly, focused laboratory studies may be useful to exclude potential medical illnesses that may present as MDD.

Prospective use of objective clinical scales, such as the Hamilton Depression Rating Scale and the Inventory of Depressive Symptomatology, and retrospective use of treatment history forms, such as the Antidepressant Treatment History Form (ATHF), can be very helpful in outlining the nature and course of the treatment resistance. Since the ATHF was initially developed, there have been several developments in the treatment of MDD and specifically TRD, some of which will be discussed further in this article. The ATHF: Short Form has been updated and revised to reflect developments in the treatment of TRD.

Learn more about the workup for TRD and MDD.


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