[jdietrich]

STAR*D presents us with a "glass half full" problem. It's absolutely true that the majority of people will recover from depression with suitable treatment, but that leaves us with a minority who won't.

I'm not sure how to communicate those facts effectively to a wide audience. It is absolutely imperative that people with depression seek treatment and keep trying even if the first or second or fifth treatment fails, otherwise we're condemning people to unnecessary suffering; conversely, a lot of people with treatment-resistant depression are doubly stigmatised because of unreasonable expectations about the efficacy of treatment.

I do think it's useful for treatment-resistant patients to shift their focus away from recovery and towards symptomatic management - it's easy to get disheartened because you're not in remission, but a treatment that takes you from 10/10 depressed to 8/10 depressed is still useful. Eking out small reductions in symptoms and small improvements in functioning can be tedious and frustrating, but it's better than resigning yourself to interminable misery.

[brookside]

The term "treatment resistant depression" bothers me because, I think, a more accurate name would be "placebo resistant depression". Sorry to come off as frustrated; I'm like others in this thread with 10+ years of trying various therapies and antidepressants to end up feeling more, not less, hopeless.

David Burns does a good job explaining why antidepressants and psychotherapy don't typically work in his most recent podcast: https://feelinggood.com/2019/11/18/167-feeling-great-profess...

While David makes a good case against drugs and non-CBT therapy, I actually don't find his his fantastical anecdotes of the light-switch effectiveness of TEAM CBT therapy convincing either.

[cassowary37]

and HN refusal to pay attention to data when it relates to depression in 3..2..1...

https://www.ncbi.nlm.nih.gov/pubmed/29477251

for moderate to severe depression, the kind most posters are talking about, they're consistently better than placebo. It is true that placebo is often effective too. But most people I talk to would rather have that extra chance of getting better.

[brookside]

"We excluded trials that included 20% or more of participants with bipolar disorder, psychotic depression, or treatment-resistant depression"

This is an honest question - is it fair to exclude people for whom antidepressants don't work in an analysis of if antidepressants work?

[chas]

If “placebo-resistant depression” and “treatment-resistant depression” were synonyms, we would expect that excluding treatment-resistant depression from your study would result in the studying showing precisely no difference between treatment and placebo. The fact that the meta-analysis shows any difference at all suggests that “treatment-resistant depression” might be a meaningful category.

[aalleavitch]

I wouldn't dismiss a meta-analysis out of hand, but at the same time...isn't there a strong pressure to publish an effect above placebo? They rated 73% of the studies as having a moderate risk of bias, and certainty of the evidence ranged from moderate to very low.

[aalleavitch]

I don't think that the real cure for depression can be bought or sold.

Bruce Alexander is talking about addiction here, but I think everything he is describing absolutely applies for depression: https://www.youtube.com/watch?v=7axaXQmdBVQ

[danaliv]

I loathe this term. It’s like they’re shifting the blame for ineffective treatments onto the depression. If the treatments don’t work, the problem is with the treatments. Come up with something else!

[ThrowawayP]

> I do think it's useful for treatment-resistant patients to shift their focus away from recovery and towards symptomatic management

Would be nice but it seems risky for a patient to suggest that to the clinician; depending on the exact symptomatic management being sought and the competence of the clinician (who are not, unfortunately, exempt from Sturgeon's Law), it might get the patient falsely labeled as "drug seeking". That would be problematic, to say the least.