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Psychosocial treatment approaches to difficult-to-treat depression

This is a republished version of an article previously published in MJA Open

Despite adequate first-line treatment for depression, 50%–60% of patients remain symptomatic.1 These people require more outpatient visits and psychotropic medications than do those who respond to initial treatment,2,3 and they continue to have impaired social and occupational functioning and morbidity from other illness.4 This difficult-to-treat depression (DTTD) is therefore a considerable burden in the community, and current management options are only partially effective.57

There are several approaches to defining DTTD.5,8,9 A common pragmatic conceptualisation is that of treatment-resistant depression, usually defined as a failure…