Understanding Treatment Resistance: Atypical vs. Melancholic Depression

A commonly referenced study from the 1990s highlights the nuances of treatment resistance in depression. Patients classified as treatment-resistant had only failed one antidepressant, challenging the accuracy of such classifications. The study compared the efficacy of two antidepressants, MAOI phenylzine and tricyclic amipramine, by switching non-responders to the alternative. The results demonstrated a higher response rate for phenylzine at 67% compared to 41% for amipramine. Importantly, 80% of the studied group exhibited atypical features, known to respond better to MAOIs, while melancholic features typically call for a tricyclic approach. This distinction underscores the need for careful assessment in prescribing treatments for depression.