Harvard Mental Health Letter

New insights into treatment-resistant depression

Psychotic symptoms, rather than unrecognized bipolar disorder, may underlie poor response.

Only one-third of patients with major depression achieve remission after trying one antidepressant. When the first medication doesn't adequately relieve symptoms, next-step options include adding a new drug to the first or switching to another drug. With time and persistence, nearly seven in 10 adult patients with major depression eventually find a treatment that works.

Of course, that also means that the remaining one-third of patients with major depression cannot achieve remission even after trying multiple options. Experts are hunting for ways to understand the cause of persistent symptoms. In recent years, one theory in particular has gained traction — that many people with hard-to-treat major depression actually suffer from bipolar disorder. However, a paper suggests otherwise, and the findings provide new insights into the nature of treatment-resistant depression.

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