Prevalence of treatment-resistant depression in primary care: cross-sectional data

I used to wonder as a GP what chance an active molecule on its own might have in addressing the depressions I saw in various patients. I now understand far better the importance of the placebo effect (another coverall term for a whole raft of inter and intra-human complex processes) and of the contexts in which a life is lived.

As the study by Thomas et al demonstrates, over 50% of patient depressions fail to respond after 6 weeks of adequate doses of antidepressants 'emphasising the need for regular review'. One would hope that such review would include a thorough assessment of associated morbidities and biopsychosocial, and dare I say it spiritual, factors if any molecule is to stand a chance against, for example, a background of abuse at home, bullying at work or debt. To say nothing of the other available approaches for depressions, such as mindfulness, systemic therapies and Men Sheds.

Doctors should be in the business of working with others to address such issues and needs, not merely assessing them and labelling people as 'treatment-resistant'. We can hit the television for all it is worth, but it is always worth ensuring the presence of connection to current and a good signal?

Conflict of Interest:

None declared