Thase and Rush developed a staging system for treatment-resistant depression.


Different classes of antidepressants:

(1) tricyclic antidepressants (TCA)

(2) monoamine oxidase inhibitors (MAO inhibitors)

(3) selective serotonin reuptake inhibitors (SSRI)

(4) serotonin-norepinephrine reuptake inhibitors (SNRI)

(5) other


Clinical Management


response to an adequate trial of an antidepressant


failure of >= 1 adequate trial of a major class of antidepressant


failure of an adequate trial of an antidepressant in a totally different class of antidepressant, following a Stage I failure


failure of an adequate trial of a tricyclic antidepressant following a Stage II failure


failure of an adequate trial of an MAO inhibitor following a Stage III failure


failure of a course of bilateral electroconvulsive therapy (ECT) following a Stage IV failure



Limitations (see Fava, page 650):

(1) The assumption is that a tricyclic antidepressant will only be used after initial response failures to other antidepressants.

(2) The inference that tricyclic antidepressants or MAO inhibitors are somehow superior to other agents.

(3) An adequate trial may differ in dose and duration.

(4) Use or response to augmentation therapy is not included.


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