As many as 35-40% of patients afflicted with Major Depressive Disorder (MDD) are treatment resistant, a situation that places a massive emotional and financial burden on society and challenges the mental health profession to develop new treatment paradigms and practices. Even the most astute clinicians can be frustrated when treatment options fail to be effective or work for only a brief time, leaving them to wonder what course to pursue next. Treatment Resistant Depression: A Roadmap for Effective Care gives clinicians and their patients what they need most desperately: a sequence of steps that reflect state-of-the-art diagnostic procedures and integrates all evidence-based treatment modalities -- in short, a roadmap to wellness and recovery.

Based primarily on the experiences of the authors, all of whom are leading researchers and/or clinicians in Treatment Resistant Depression and affiliated with the University of Michigan Comprehensive Depression Center, the book also draws upon the clinical research advances and treatment innovations of programs around the world. Although the book's step-by-step organization is clear and easy to follow, its coverage, scope, and level of sophistication are anything but simplified. This book - Is comprehensive, addressing treatment options, including psychopharmacotherapy, psychotherapy, neuromodulation (ECT, transcranial magnetic stimulation, deep brain stimulation, vagus nerve stimulation), exercise, nutrition, self-management approaches to enhance adherence, behavioral sleep programs, and others- Addresses treatment resistant depression across the lifespan, reflecting the diverse demographics of depression, which knows no age, gender, or socioeconomic status- Emphasizes the authors' commitment to early intervention and provides techniques for identifying young people who are at risk for developing depression or already expressing symptoms of the disease- Recognizes the chronicity of depression, rather than focusing on only the acute stage, and in this way allows for more effective treatment over the patient's lifetime- Introduces self-management as playing a critical role in the patient's prognosis, engagement, adherence to clinical steps that help maintain recovery, and self-esteem- Promotes the development of new, personalized, and predictive biomarkers to target treatment more effectively.

Designed to be useful across disciplines and treatment modalities, the book includes a multitude of tables, graphs, and learning aids that will benefit students, instructors, and clinicians. At the same time, the book promises to be a valuable resource for patients and their families, since Treatment Resistant Depression is both difficult to live with and little understood. No other book offers so much practical guidance, sound research and hope.

Based on powerful epidemiological data such as numbers afflicted, mortality rates from suicide, personal and familial consequences, and skyrocketing fiscal costs, major depressive disorder (MDD) has the sad and ignominious distinction of being a leader among disabling disorders worldwide.

With lifetime prevalence risks of 13% for men and 21% for women, the magnitude of this crisis cannot be understated. This hard-hitting volume focuses on recurrences -- perhaps most important among the many factors (others include extreme underdiagnosis and undertreatment, genetic vulnerability, frequent recurrences, severe stigma and poor adherence with maintenance treatment, and brain tissue degenerative changes associated with recurrences and chronic depression) that contribute to MDD's high morbidity.

Following an introduction by the editor detailing the overwhelming personal and societal burden created by MDD, the distinguished authors of this volume emphasize five critical topics: - The lifetime impact of gender on recurrent MDD in women, emphasizing the clinical features, treatment, and prevention strategies of the illness during three key periods of hormone transition (adolescence, childbearing years, and middle life) and including recommendations on where future research should focus.- Treatment strategies for chronic and recurrent depression to help prevent acute episodes from developing into long-term depression, specifically addressing the continuing question of whether pharmacotherapy and psychotherapy combinations are superior to either alone.- Prevention of recurrences in bipolar patients, updating the demonstrated benefits of several new anticonvulsant mood stabilizers and integrative treatment approaches and suggesting that treatment success depends on a multifaceted approach that combines old and new pharmacotherapy.- Potential applications of new somatic treatment strategies involving minimally invasive brain stimulation that have greatly reduced the stigma but done little to advance the diagnosis and treatment of neuropsychiatric illnesses, with exciting data suggesting the efficacy of vagal nerve stimulation (VNS) and repetitive transcranial magnetic stimulation (TMS).- A "call to arms" with updated recommendations on how to ensure demonstrable, lasting progress in preventing recurrences of depression, which -- along with other chronic diseases such as diabetes, heart disease, and schizophrenia -- progresses throughout life unless actively treated.

This highly informative volume, clearly written and exceptionally well referenced, is a "must-read" for every clinician, including specialists in depression and clinical neurosciences, primary care physicians and mental health clinicians interested in learning more about how to successfully treat what remains one of our most recalcitrant, debilitating illnesses.