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Treatment Resistant Depression

A Roadmap for Effective Care

Edited by John F. Greden, M.D., Michelle B. Riba, M.D., M.S., and Melvin G. McInnis, M.D.
University of Michigan Comprehensive Depression Center

  • ISBN 978-1-58562-953-4
  • Item #62953

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As many as 35-40% of patients afflicted with Major Depressive Disorder (MDD) are treatment resistant, a situation that places a massive emotional and financial burden on society and challenges the mental health profession to develop new treatment paradigms and practices. Even the most astute clinicians can be frustrated when treatment options fail to be effective or work for only a brief time, leaving them to wonder what course to pursue next. Treatment Resistant Depression: A Roadmap for Effective Care gives clinicians and their patients what they need most desperately: a sequence of steps that reflect state-of-the-art diagnostic procedures and integrates all evidence-based treatment modalities—in short, a roadmap to wellness and recovery.

Based primarily on the experiences of the authors, all of whom are leading researchers and/or clinicians in Treatment Resistant Depression and affiliated with the University of Michigan Comprehensive Depression Center, the book also draws upon the clinical research advances and treatment innovations of programs around the world. Although the book's step-by-step organization is clear and easy to follow, its coverage, scope, and level of sophistication are anything but simplified. This book

  • Is comprehensive, addressing treatment options, including psychopharmacotherapy, psychotherapy, neuromodulation (ECT, transcranial magnetic stimulation, deep brain stimulation, vagus nerve stimulation), exercise, nutrition, self-management approaches to enhance adherence, behavioral sleep programs, and others
  • Addresses treatment resistant depression across the lifespan, reflecting the diverse demographics of depression, which knows no age, gender, or socioeconomic status
  • Emphasizes the authors' commitment to early intervention and provides techniques for identifying young people who are at risk for developing depression or already expressing symptoms of the disease
  • Recognizes the chronicity of depression, rather than focusing on only the acute stage, and in this way allows for more effective treatment over the patient's lifetime
  • Introduces self-management as playing a critical role in the patient's prognosis, engagement, adherence to clinical steps that help maintain recovery, and self-esteem
  • Promotes the development of new, personalized, and predictive biomarkers to target treatment more effectively.

Designed to be useful across disciplines and treatment modalities, the book includes a multitude of tables, graphs, and learning aids that will benefit students, instructors, and clinicians. At the same time, the book promises to be a valuable resource for patients and their families, since Treatment Resistant Depression is both difficult to live with and little understood. No other book offers so much practical guidance, sound research and hope.


  • Contributors
  • Disclosure of Interests
  • Foreword
  • Preface
  • Dedication and Acknowledgements
  • Chapter 1. Treatment resistant depression: overview of the University of Michigan Depression Center roadmap
  • Chapter 2. Psychopharmacological roadmap for treatment resistant depression
  • Chapter 3. Treatment resistant depression in adolescents
  • Chapter 4. Recognizing and treating depression and bipolar disorder on college campuses: early identification and intervention
  • Chapter 5. Treatment resistant depression in pregnant women
  • Chapter 6. Treatment resistant depression in later life
  • Chapter 7. Treatment resistant depression and comorbid medical problems: Cardiovascular disease nd cancer
  • Chapter 8. Alcohol and drug use: Contributions to treatment resistance for patients with depression
  • Chapter 9. Sleep and circadian rhythms: A understudied area in treatment resistant depression
  • Chapter 10. Psychotherapy strategies for treatment resistant depression
  • Chapter 11. Device-related neuromodulation in treatment resistant depression
  • Chapter 12. Exercise, nutrition, and treatment resistant depression
  • Chapter 13. The bipolar disorder medical care model: A collaborative approach for reducing disparities in medical care among patients with bipolar disorder
  • Chapter 14. Expanding services for patients with treatment resistant depression: The role of peer support
  • Chapter 15. Genetics of mood disorders: general principles and potential applications for treatment resistant depression
  • Index


    Iyad Alkhouri, M.D.
    Roseanne Armitage, Ph.D.
    J. Todd Arnedt, Ph.D.
    Virginia Barbosa, M.D.
    Kirk J. Brower, M.D.
    Paul Burghardt, Ph.D.
    Simon Evans, Ph.D.
    Heather A. Flynn, Ph.D.
    Neera Ghaziuddin, M.D., M.R.C.Psych.
    Rachel Lipson Glick, M.D.
    Mona Goldman, Ph.D.
    David E. Goodrich, M.S., M.A., Ed.D.
    John F. Greden, M.D.
    Joseph Himle, Ph.D.
    Victor Hong, M.D.
    Helen C. Kales, M.D.
    Masoud Kamali, M.D.
    Kevin Kerber, M.D.
    Amy M. Kilbourne, Ph.D., M.P.H.
    Cheryl King, Ph.D.
    Daniel F. Maixner, M.D.
    Susan Maixner, M.D.
    Sheila M. Marcus, M.D.
    Melvin G. McInnis, M.D.
    Brian Mickey, M.D., Ph.D.
    Erin Miller, M.S.
    Maria Muzik, M.D., M.Sc.
    John M. Oldham, M.D., M.S.
    Parag G. Patil, M.D., Ph.D.
    Paul Pfeiffer, M.D., M.S.
    Michelle B. Riba, M.D., M.S.
    Kathryn Roeder, B.S.
    Srijan Sen, M.D., Ph.D.
    Todd Sevig, Ph.D.
    Lisa S. Seyfried, M.D.
    Claire Stano, M.A.
    Kiran Taylor, M.D.
    Stephan F. Taylor, M.D.
    Jamie Travis, B.A.
    Marcia Valenstein, M.D., M.S.
    Delia Vazquez, M.D.
    Heather Walters, M.S.
    Robert Winfield, M.D.
    Kara Zivin, Ph.D.

About the Authors

John F. Greden, M.D., is Rachel Upjohn Professor of Psychiatry and Clinical Neurosciences, University of Michigan; Executive Director, University of Michigan Comprehensive Depression Center; Research Professor, Molecular and Behavioral Neurosciences Institute; and Chair, National Network of Depression Centers.

Michelle B. Riba, M.D., M.S., is Clinical Professor; Associate Director, Michigan Institute for Clinical and Health Research; Associate Director, University of Michigan Comprehensive Depression Center; Associate Chair for Integrated Medical and Psychiatric Services, University of Michigan, and Past President, American Psychiatric Association.

Melvin G. McInnis, M.D., is Thomas B. and Nancy Upjohn Woodworth Professor of Bipolar Disorder and Depression; Professor of Psychiatry; Associate Director, University of Michigan Comprehensive Depression Center; and Section Director, Depression Center, University of Michigan.

Dr. Greden and colleagues have written a road map for treatment resistant depression that has immediate appeal for the general practitioner and mood specialist alike. The case vignettes with evidenced based reviews and clinical pearls in mood disorders with emphasis on areas often underdeveloped (young adults, dual diagnosis, late life) make Treatment Resistant Depression: A Roadmap for Effective Care a great resource for my practice and my patients.—Mark A. Frye, M.D., Professor of Psychiatry, Director, Integrated Mood Group, Mayo Clinic, Department of Psychiatry

Many of the case vignettes represent some of the patients who have been referred to me because they suffer from treatment resistant depression. Several chapters cover patient populations that are often underrepresented in the current literature. While I would recommend reading the first chapter before the other chapters, any chapter can be read in a relatively short time to get clear and concise information on a specific case. The well-written concluding chapter on genetics updates readers on the current research in this exciting area, which has great potential for use in treatment resistant depression. While complementary and alternative treatments are interspersed throughout the book, a specific chapter that reviews all of the potential treatment options that patients are pursuing outside of the traditional medical model, and the research findings behind those treatments, would have been a helpful addition.—Aaron Plattner, M.D.,, Doody's Publishers' Club, 7/1/2011

This book provides the reader with a well written and concise review of the current literature regarding treatment-resistant depression. It is targeted toward providing treating clinicians with an overview of currently developed treatment algorithms for treatment-resistant depression as well as toward providing them with information on other avenues that they may not have considered.—Jonathan Boyer, M.D., The American Journal of Psychiatry, 7/1/2011

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