Refractory to Treatment

If despite over 3 months of antidepressant treatment and/or psychotherapy, your patient has had less than 50% drop in PHQ-9 score, then criteria are met for refractory depression. 

Any of the following present?

1. Non-adherence to medication

2. Undiagnosed organic medical condition

3. Another psychiatric condition or issue such as:

• Psychosis?
• Bipolar?
  • MDQ
• Alcohol / substance use issues?
  • Consider asking questions from the AUDIT-C
  • For drug use ask "How many times in the past year have you used an illegal drug or used a prescription medication for non-medical reasons?" (response of 1 or greater is considered positive)
    • if positive response consider asking questions from the DAST-10
• Personality disorder
  •  Borderline Personality screener.pdf (seven or more positive responses is a positive screen)
• Domestic violence? Consider using the 4-item HITS
• Past history of abuse/trauma?
• Sexual identity or orientation issues?
• Any other  psychosocial stressors? (e.g. relationship, work, school, finances)