期刊
JOURNAL OF AFFECTIVE DISORDERS
卷 87, 期 2-3, 页码 185-191出版社
ELSEVIER SCIENCE BV
DOI: 10.1016/j.jad.2005.02.015
关键词
depression; bipolar disorder; treatment resistance
资金
- NIMH NIH HHS [MH 58356, MH 61587, N01 MH 90003, N01 MH 80001-01] Funding Source: Medline
Background: 'Treatment resistant depression' is likely to emerge from a number of factors, including application of the wrong diagnostic and treatment models. Method: Current paradigms for managing both depression and treatment resistant depression are considered. We then examine the prevalence of a set of paradigm failures that appeared to contribute to treatment resistant depression in outpatients of a tertiary referral Mood Disorders Unit. Results: Six illustrative paradigm failures are described and their frequencies within the clinical sample reported. Identified paradigm failures were diagnosing and/or managing a non-melancholic condition as if it were melancholic depression, failure to diagnose and manage bipolar disorder, psychotic depression or melancholic depression, misdiagnosing secondary depression and failure to identify organic determinants. Conclusion: We suggest that the identification of such 'paradigm failures'-and of others that can be assumed to operate-has the potential to enrich the assessment and management of depressed patients, and reduce the prevalence of treatment resistance. (c) 2005 Elsevier B.V. All rights reserved.
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