Psychiatric comorbidities in treatment-resistant depression: Insights from a second-opinion consultation case series

Approximately one-third of patients with major depression do not improve sufficiently even after multiple trials of otherwise effective antidepressant treatments, meeting criteria for treatment-resistant depression (TRD). The phenomenon of TRD remains poorly understood, as it can be attributed to a myriad of diverse factors, including pharmacogenetic variations and underdiagnosed or untreated comorbid psychopathology. This series of six case reports from an innovative second-opinion consultation program brings into focus some of the most prevalent psychiatric comorbidities in TRD: anxiety disorders, “double depression” (a combination of dysthymia and major depressive disorder), and personality psychopathology and discusses implications for their assessment and treatment. It also highlights the benefits of incorporating psychological testing in second-opinion evaluations toward increased accuracy and reliability of assessment of co-occurring psychiatric disorders. This enhanced approach to re-evaluation of patients with TRD may lead to more highly personalized treatment recommendations and better treatment outcomes.