University Psychiatric Center KU Leuven and KU Leuven, Faculty of Medicine, Department of Neurosciences, Research Group Psychiatry.
University Psychiatric Center KU Leuven, Campus Kortenberg.
Int J Neuropsychopharmacol. 2019 Feb 1;22(2):85-92. doi: 10.1093/ijnp/pyy052.
Treatment-resistant depression refers to major depressive disorder, treatment of the disorder, and failure to obtain an "acceptable" outcome. Regarding the disorder, the heterogeneous concept of major depressive disorder and the multiple definitions of treatment-resistant depression, hesitating between a categorical and a more dimensional approach, as well as the divergence between diagnostic criteria and the items in the assessment scales are a source of confusion. Classifications do not take into account the dramatic influence of patient characteristics strongly impacting outcome, although these can be the cause of so-called pseudo-resistance. Outcome is the result of spontaneous evolution, nonspecific factors (including placebo), and active treatment factors. These should be differentiated to have a reliable estimation of the impact of different treatment modalities before we can asses treatment-resistant depression or before we can ascertain the (non)efficacy of treatments for treatment-resistant depression.The impact and burden of major depressive disorder and treatment-resistant depression are immense and go far beyond their economic cost. It is often forgotten that both are not only associated with increased suicidality but also with nonsuicidal mortality and that both can even result in requests for assisted dying. The caregiver burden and associated stigma are also too often overlooked despite that it has been suggested that they do influence (treatment) outcome.
治疗抵抗性抑郁症是指重性抑郁障碍、该障碍的治疗以及未能获得“可接受”的结果。关于该障碍，重性抑郁障碍的异质性概念和治疗抵抗性抑郁症的多种定义、在分类法和更具维度的方法之间犹豫不决、诊断标准和评估量表中的条目之间的分歧，这些都是造成混淆的原因。分类法没有考虑到强烈影响结局的患者特征的巨大影响，尽管这些可能是所谓的假性抵抗的原因。结局是自发演变、非特异性因素（包括安慰剂）和积极治疗因素的结果。应该对这些因素加以区分，以便在评估治疗抵抗性抑郁症之前可靠地估计不同治疗方式的影响，或者在确定治疗抵抗性抑郁症的治疗方法（无效）之前可靠地估计不同治疗方式的影响。重性抑郁障碍和治疗抵抗性抑郁症的影响和负担是巨大的，远远超出其经济成本。人们常常忘记，两者不仅与自杀率增加有关，而且与非自杀性死亡率有关，两者甚至可能导致请求协助自杀。尽管有人认为它会影响（治疗）结局，但护理者负担和相关耻辱感也经常被忽视。
