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Still Down: What to Do When Antidepressants Fail

by Dean MacKinnon Johns Hopkins University Press
Pub Date:
Pbk 152 pages
AU$37.99 NZ$39.12
Product Status: In Stock Now
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Major depressive disorder is a common medical condition that can be disabling and can persist for months, even years. Many people experience depression symptoms that resist treatment. Although they try various combinations of medications, psychotherapy, or electroconvulsive therapy, their symptoms don’t improve. What can people who have treatment-resistant depression do to overcome their depression and feel better?


In Still Down, Dr. Dean F. MacKinnon, a psychiatrist at Johns Hopkins Medical School, presents nine composite stories drawn from patients he has seen in his twenty years as an expert in treatment-resistant mood disorders. The first section of the book features people diagnosed with depression who have not yet received appropriate treatment. The next section looks at misdiagnosis, focusing on people who feel and appear depressed but who have different mood disorders and need treatment for them. Finally, Dr. MacKinnon describes people who have severe depression that does not respond to any treatment, regardless of how finely tuned the treatment might be. These people, who suffer from true treatment-resistant depression (TRD), can benefit from a variety of treatments to feel better.


Dr. MacKinnon provides commentary to explain and extend the discussion of the patients and situations in each case. He also discusses common obstacles to improvement, including overly conservative dosing, problems stemming from not adhering to treatment, antidepressant failure, and high sensitivity to side effects. By identifying aspects of the individual’s qualities, behaviors, and experiences that may account for poor response to treatment,  Still Down points the way for people with TRD and their families to find appropriate diagnoses and the best possible care.


List of Tables
 Section I: Fundamentals
            Ann: Textbook depression
            Bob: Treatment ambivalence
            Carla: Underdosing
 Section II: Misdiagnosis
            Darius: Demoralization
            Evelyn: Bipolar depression
            Frances: Overmedication
 Section III: Treatment Resistant Depression
            Gary: Double depression
            Hannah: Residual depression
            Irma: Treatment refractory depression
 Appendix A: Common therapeutic practices to boost antidepressant response
Appendix B: Assessment of the patient with antidepressant failure

"An interesting patient-oriented guide to understanding chronic depression and the range of potentially effective treatment options."

— Bradley Gaynes, MD, MPH, University of North Carolina Hospitals at Chapel Hill
Dean F. MacKinnon, M.D., is an associate professor in the Department of Psychiatry and Behavioral Sciences at the Johns Hopkins University School of Medicine.