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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 8 of 8. This is the beginning of the thread.
Posted by Phillipa on November 13, 2009, at 13:43:02
Seriously this is a positive and easy to understand description of treatment resistant depression, the whys, how to treat, and hope to all. Hope you can access the link if not google as it's three pages long. Phillipa
Posted by ricker on November 13, 2009, at 14:19:10
In reply to What Is TX Resistant Depression + All Treatments, posted by Phillipa on November 13, 2009, at 13:43:02
I suppose lots of us here can relate to the article. I kinda new I was treatment resistant after my course of ECT in 1989!!! Lets keep on hoping the newer meds coming down the pipeline will make "treatment resistant" a thing of the past!
Regards, Rick
Posted by SLS on November 13, 2009, at 14:39:41
In reply to What Is TX Resistant Depression + All Treatments, posted by Phillipa on November 13, 2009, at 13:43:02
There is no universally accepted definition of what constitutes treatment resistant depression (TRD). Any definition of TRD is bound to use criteria that are to some degree arbitrary. Here is an example of a definition that includes "staging" to describe the degree of resistance.
From Thase and Rush - J Clin Psychiatry 1997;58(Suppl 13):239.
Measuring TRD: Staging Treatment ResistanceStage I: Inadequate response to 1 monotherapy
Stage II: Inadequate response to 2 adequate monotherapy trials (different classes)
Stage III: Stage II resistance plus inadequate response to 1 augmentation trial
Stage IV: Stage III resistance plus inadequate response to a second augmentation trial
Stage V: Stage IV resistance plus inadequate response to bilateral ECT
- Scott
Posted by Maxime on November 13, 2009, at 14:56:00
In reply to What Is TX Resistant Depression + All Treatments, posted by Phillipa on November 13, 2009, at 13:43:02
I was hoping that there would be something "new" in the article. Something that I could try.
Posted by Phillipa on November 13, 2009, at 19:56:04
In reply to Re: What Is TX Resistant Depression + All Treatments » Phillipa, posted by Maxime on November 13, 2009, at 14:56:00
Maxie I'm sorry. But isn't the parnate working well? Love Phillipa
Posted by southernsky on November 14, 2009, at 13:03:16
In reply to What Is TX Resistant Depression + All Treatments, posted by Phillipa on November 13, 2009, at 13:43:02
Here's a view from a professor at Columbia University about poor drug treatment response:
But in fact there is a body of literature that shows that when patients have a comorbid
personality disorder, its more difficult to treat their Axis I conditions. For example, if you have a patient who is depressed and who has narcissistic or borderline PD, that person is likely going to be difficult to treat. They may be failing various trials of meds, and knowing about their PD would be very helpful in understanding why. Or, a patient with panic disorder may not be responding to medication because they have a comorbid avoidant personality disorder. This is one reason drug companies exclude such patients from clinical trials, because they want the best response rate they can get.http://www.thecarlatreport.com/expertqa/diagnosing-personality-disorders
Hope it is helpful for some. I thought this interview was very interesting and informative.
Posted by Phillipa on November 14, 2009, at 20:16:07
In reply to Re: What Is TX Resistant Depression + All Treatments, posted by southernsky on November 14, 2009, at 13:03:16
I read it in the other link you posted it and it was excellent thanks Phillipa
Posted by southernsky on November 15, 2009, at 11:48:28
In reply to Re: What Is TX Resistant Depression + All Treatments » southernsky, posted by Phillipa on November 14, 2009, at 20:16:07
Your welcome Phillipa!
http://www.medscape.com/viewarticle/431515_3
There's a lot on the significance of PDs with TRD. But I can't access the journal articles here, so found another one elsewhere.
Of course, I don't know anyone who does not have traits of a PD, but it might make a difference to know if those factors effect your treatment.
In today's world of 15 minute psych visits, its not always (usually?) considered, and from my experience, pdocs don't do the types of interviews necessary to screen for them.
Take care!
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