TREATMENT-RESISTANT DEPRESSION IN AN AUSTRALIAN CONTEXT .1. THE UTILITY OF THE TERM AND APPROACHES TO MANAGEMENT

The concept of ''treatment resistant depression'' (TRD) has generally been defined in terms of failure to respond to a standard course of so matic therapy with little reference to diagnostic sub-types or relevan t psychosocial factors. In this paper we examine problems with the use of the term ''treatment resistant depression'' and then outline an ap proach to TRD employed in an Australian mood disorders unit. After dis cussing the need for a biopsychosocial assessment, multimodal manageme nt strategies for melancholic and nonmelancholic TRD patients are desc ribed.