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Treatment-resistant depression complicates patient care and increases health care burden.3,8 Although there is no agreed-upon clinical definition for treatment-resistant depression, the working definition is an inadequate response to at least 2 antidepressant trials, with agents of differing classes of adequate dose and duration and treatment adherence.3 Table 1 describes in greater detail a system of staging treatment-resistant depression.9 The primary diagnosis of MDD should be confirmed in patients who appear to have treatment-resistant depression

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