Refractory Depression

Refractory Depression

J.D. Amsterdam

New York, NY: Raven Press, Vol 2 in Advances in Neuropsychiatry and Psychopharmacology, 249 pp., 1991

In spite of the proven efficacy of antidepressants in the treatment of major depressions, clinicians have recognized over the past 30 years that at least 30% of their patients fail to respond adequately to treatment. As depression is associated with definite morbidity and mortality, it is surprising the less than adequate attention has been given by researchers both in academia and the pharmaceutical industry to the phenomena of “refractory depressions.” A number of methodological issues have confounded research in this important area. Just a few of the many factors that researchers have to account for in dealing with the phenomena of “failure to respond” are the lack of agreement on a clear definition of “response”; the recognized heterogeneity of depressions; and, the absence of clear guidelines for alternative approaches. In that light, this book in an important contribution for both clinicians and researchers. Its 24 chapters are a broad spectrum of issues important for the current understanding of the phenomena of refractoriness as well as clinical and experimental approaches in dealing with it. As in any book with multiple contributors, the quality of chapters varies widely.

Obviously, the book concentrates on biological issues important in the understanding of the pathophysiology of depression as well as the number of biological treatment strategies that have proved effective in the management of depression. The book would have benefited from a chapter on psychosocial aspects and the possible role of “extrapharmacological factors” as adjunctive approaches in manipulation of treatment resistance. However, overall the book provides valuable information for both researchers and clinicians on a clinically important issue.