If despite over 3 months of antidepressant treatment and/or psychotherapy, your patient has had less than 50% drop in PHQ-9 score, then criteria are met for refractory depression.
Any of the following present?
1. Non-adherence to medication
2. Undiagnosed medical condition
3. Another psychiatric condition or issue such as:
- Alcohol / substance use issues?
- Domestic violence? Consider using the 4-item HITS
- Past history of abuse/trauma?
- Sexual identity or orientation issues?
- Any other psychosocial stressors? (e.g. relationship, work, school, finances)