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Refractory to Treatment

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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 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
  • 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)




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