Nearly two in five youth with major depressive disorder fail to respond to first-line interventions. As such, treatment-resistant depression represents a formidable challenge for clinicians and researchers. In fact, even considering the diagnosis of treatment-resistant depression in children and adolescents requires (a) defining treatment-resistant depression and, by extension, treatment failure; (b) defining recovery; (c) understanding its developmental trajectory; and in addition to (d) understanding the evidence for treatment interventions in this population. Accumulating data suggest that treatment-resistant depression is heterogeneous and that this heterogeneity may inform interventions. Additionally, these data suggest that substantially more nuance is needed in evaluating the 'adequacy' of prior treatments whether they are psychotherapeutic or psychopharmacologic. Last, adjunctive interventions that focus on neuromodulation, glutamatergic, GABAergic, and inflammatory pathways remain poorly understood in youth with treatment-resistant depression despite very significant advances in adults with treatment-resistant depression.

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评论：治疗失败和成功：关于定义和治疗儿科难治性抑郁症的评论——对 Dwyer 等人的反思。（2020 年）。

近五分之二的重度抑郁症青年对一线干预措施没有反应。因此，难治性抑郁症对临床医生和研究人员来说是一项艰巨的挑战。事实上，即使考虑儿童和青少年难治性抑郁症的诊断，也需要 (a) 定义难治性抑郁症，进而定义治疗失败；(b) 界定恢复；(c) 了解其发展轨迹；除了 (d) 了解对该人群进行治疗干预的证据。越来越多的数据表明，难治性抑郁症具有异质性，这种异质性可能会为干预措施提供信息。此外，这些数据表明，在评估“充分性”时需要更多的细微差别 先前的治疗，无论是心理治疗还是精神药理学。最后，尽管在患有难治性抑郁症的成年人中取得了非常显着的进展，但针对神经调节、谷氨酸能、GABA 能和炎症通路的辅助干预在患有难治性抑郁症的青少年中仍然知之甚少。