@article{ref1,
title="Treatment-resistant depression: definition and treatment approaches",
journal="Journal of clinical psychiatry",
year="1990",
author="Nierenberg, A. A. and Amsterdam, J. D.",
volume="51 Suppl",
number="",
pages="39-47; discussion 48",
abstract="Little systematic attention has been directed toward the subject of treatment-resistant depression. Although these patients constitute a distinct minority, their treatment consumes a major portion of the clinician's time. Thus, the authors address the problems of defining and treating the estimated 750,000 patients with treatment-resistant depression. Several major factors concerning treatment-resistant depression appear evident: (1) although there is an emerging consensus of what constitutes &quot;adequate&quot; treatment, the majority of patients receive suboptimal drug regimens; (2) misdiagnosis of depression subtypes can lead to suboptimal treatment and &quot;pseudo-resistance&quot; to drug therapy; (3) treatment strategies for resistant depression should use systematic algorithms to avoid confusion and limit &quot;therapeutic nihilism&quot; in the patient and physician; and (4) the patient's risk/benefit ratio for each successive treatment application must be considered with the potential benefit weighed against the increasing risk of illness morbidity and likelihood of adverse events and/or suicide.<p /><p>Language: en</p>",
language="en",
issn="0160-6689",
doi="",
url="http://dx.doi.org/"
}