Is treatment‑resistant depression a myth? Discover why the diagnosis may be flawed and what the data really show.
In this live July 4th episode, Dr. Nassir Ghaemi argues that “treatment‑resistant depression” is a misnomer born from an invalid DSM construct—major depressive disorder (MDD). He explains that if the underlying diagnosis is a mixed bag of distinct depressive states, no single class of antidepressant can reliably work.
The STAR*D study showed a stepwise drop in response: about 50 % improve on a first SRI, 30 % on a second, and only 15 % after three trials, with 85 % ultimately non‑responsive. Moreover, 40‑65 % of those who initially respond relapse within three to six months, and meta‑analyses confirm no maintenance benefit after six months (see https://pubmed.ncbi.nlm.nih.gov/19594510/ and https://www.psychiatrist.com/jcp/review-maintenance-trials-major-depressive-disorder/).
Dr. Ghaemi points out that the core issue is the scientific invalidity of MDD, not a failure of drug mechanisms. He calls for revised diagnostic categories and therapies that prevent future episodes rather than merely suppress symptoms. Read the supporting articles on the antidepressant relapse rate (https://pubmed.ncbi.nlm.nih.gov/22370491/), the six‑month maintenance meta‑analysis (https://www.nature.com/articles/s41380-020-0843-0), and explore more at psychiatryletter.com. Subscribe for more deep dives into psychiatry.