The Deceptive Manifestations of Treatment Resistance in Depression: A New Look at the Problem

Abstract

In the past decade, the number of papers dealing with
\ntreatment resistance in depression has increased to a considerable
\ndegree. It has recently been discussed whether
\ncurrent definitions of treatment resistance are appropriate:
\nissues of misdiagnosis, diagnostic and biological heterogeneity,
\nand suboptimal therapeutic strategies have
\nbeen raised [1–3]. However, current conceptualizations
\nof treatment resistance focus on the characteristics of the
\npatient (whether neurobiological assets, or attitudes, or
\npsychiatric comorbidity) for the insufficient effectiveness
\nof antidepressant drugs and omit any reference to the potential
\niatrogenic effects of treatment [4], as if, in the field
\nof infectious disease, treatment resistance were conceptualized
\nindependently of the previous use of antibiotics.
\nWe will try to outline some historical developments of
\nthe concept of treatment resistance in depression and
\nhow a different assessment strategy is required to address
\ncurrent clinical challenges.

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