DEGREES OF TREATMENT RESISTANCE IN DEPRES SIVE-DISORDERS ON THE BASISOF SOMATOTHERAPEUTIC TRIALS

This brief survey is not a systematic review of the literature on trea tment-resistent depression (TRD). Rather, in the light of results of c ontrolled clinical trials, proposals for assessment of TRD are made: F irst-degree treatment resistance implies nonresponse to standard antid epressive therapy (two successive adequate treatments with antidepress ants, combined with induced-wakefulness therapy). Second-degree treatm ent resistance is defined by nonresponse to alternative treatment stra tegies (MAO inhibitors, lithium augmentation, electroconvulsive therap y, infusion therapy) that have proved to be effective in TRD both in c linical practice and in systematic investigations. In this therapeutic situation, the only option still open is to resort to previously inef fective therapy or to turn to (as yet) inadequately established therap eutic strategies. Criteria for third-degree treatment resistance shoul d not be based on nonresponse to specific further therapeutic trials b ut on the duration of the treatment (at least 2 years).