How do you define treatment-resistant depression in your practice?

Well, technically, treatment-resistant depression is defined as no meaningful response after at least two trials of antidepressants at therapeutic doses and durations (≥8 weeks). The first step is to rule out inadequate dosing (try to reach the max dose), poor adherence, and medical comorbidities that could be causing overlapping symptoms.

For patients with a true incomplete or absent response, I usually make sure they are getting therapy (alwasy a good idea and most effective), and then offer augmentation with either a second-generation antipsychotic, second generation andidepressant, or switching primary agents (although, if there is any response at all, even a slight, partial one, I favor augmentation). If that doesn't work, then I will ...