Portal de Periódicos da CAPES

THE ROLE OF AXIS II COMORBIDITY IN THE MANAGEMENT OF PATIENTS WITH TREATMENT-RESISTANT DEPRESSION

1996; Elsevier BV; Volume: 19; Issue: 2 Linguagem: Inglês

10.1016/s0193-953x(05)70289-6

1558-3147

Michael E. Thase,

Treatment of Major Depression

The role of personality disorders in the management of chronic, treatment-refractory depressive states is one of the least studied, yet more interesting topics in the treatment of mood disorders.91 When empiric data are lacking, expert opinion and clinical experience assume a greater degree of importance; yet here, again, there is not strong consensus about the significance of personality traits and disorders in refractory depression. At one extreme is the view that depressive phenomenology colors personality to such an extent that valid assessment is impossible. At the other extreme is the view that antidepressant resistance is uncommon in people with “healthy” personalities. This article addresses the relationship between treatment resistance and personality disorders and related factors. After summarizing the American Psychiatric Association Diagnostic and Statistical Manual of Mental Disorders, 4th edition (DSM-IV) Axis II disorders, the relationship between depression and personality disorders is reviewed. Next, the relationship between antidepressant response and personality traits and disorders is evaluated, with attention also given to the related issues of cognitive distortions, social support, and stressful life events. Finally, an integrated model of treatment is presented, which emphasizes the use of targeted psychotherapeutic strategies, in sequence or in combination with pharmacotherapy, to help these long-suffering individuals to cope better with their difficulties and begin to rebuild more gratifying and productive lives.