Pharmacotherapy and Ketamine Assisted Psychotherapy for Treatment-Resistant Depression: A Patient With Lifelong Self-Doubt and Self-Criticism.

Treatment-resistant depression (TRD) is most commonly defined by at least two prior treatment failures with adequate dose and duration, though consensus is lacking. A clinical case illustrates a patient with long-standing depression and inadequate treatment response, where persistent self-criticism appears to drive unrelenting symptoms, intense anger, self-doubt, and self-disapproval. The article explores potential causes of self-criticism, its impact on depression and help-seeking, and plausible treatment approaches.

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Abstract

Although consensus in the field is lacking, the most common definition for treatment-resistant depression (TRD) requires a minimum of 2 prior treatment failures with confirmed adequate dose and duration. This article presents a clinical example of TRD in a patient with a long history of depression and inadequate response to treatment. The prominent feature is the patient's persistent self-criticism that might have predisposed him to unrelenting depression symptoms, intense anger, self-doubt, and self-disapproval. We explore potential underlying causes for self-criticism, its impact on depression and help-seeking, and plausible treatment approaches.