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Treatment Resistant Depression: A Roadmap for Effective Care

edited by John F. Greden,, M.D., Michelle B. Riba,, M.D., M.S., and Melvin McInnis, M.D. Washington, DC, American Psychiatric Publishing, 2011, 364 pp., $69.00.

Reviewed by Jonathan Boyer, M.D.
Am J Psychiatry 2012;169:668-668. doi:10.1176/appi.ajp.2011.11121784
View Author and Article Information
Denver, Colo.

Dr. Boyer is affiliated with the Department of Psychiatry, University of Colorado, Denver.

The author reports no financial relationships with commercial interests.

Book review accepted for publication December 2011.

Accepted December , 2011.

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This book provides the reader with a well written and concise review of the current literature regarding treatment-resistant depression. It is targeted toward providing treating clinicians with an overview of currently developed treatment algorithms for treatment-resistant depression as well as toward providing them with information on other avenues that they may not have considered.

An important distinction that is made early on in the book is that treatment-resistant depression is better categorized as a heterogeneous group of “treatment resistant depressions” rather than a homogenous condition. This is an important concept because mental health clinicians are facing an ever-growing number of patients who have not responded to prior trials of treatment for their depression. In this vein, the book provides the reader with real-world advice when treating these individuals.

The first chapter begins with an overview of what constitutes treatment-resistant depression, addressing contributing factors, and provides a “roadmap” for effectively treating the disorder. In subsequent chapters, each of the strategies discussed in the initial roadmap for recovery are addressed in further detail, including discussions on psychopharmacology, evidence-based psychotherapies, and somatic treatments (i.e., ECT, repetitive transcranial magnetic stimulation). This is done in a readily accessible manner, since clinical vignettes are provided and discussed in each chapter to highlight when certain interventions should be considered and why. In addition, key concepts are emphasized at the end of each chapter, providing a good synopsis.

Many of the chapters also discuss comorbid conditions that often affect our ability as clinicians to provide care for this patient population, for example, co-occurring substance use disorders as well as comorbid medical illnesses in elderly patients, both of which can lead to suboptimal treatment if not factored into decisions when addressing the treatment-resistant depression. Throughout the book, additional information sources are provided, which I also found to be useful, for instance, the REPROTOX website, recommended in the chapter on treatment-resistant depression during pregnancy.

This book provides a useful summary of the current, available literature on evidence-based approaches in managing treatment-resistant depression. Given the prevalence of depression that is resistant to treatment, this book could serve as a good guide for the clinician who feels “stuck” and unable to help his or her patients, especially since such feelings on the part of the clinician are often echoed by the patient.




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