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Carl Salzman, MD, Discussant

JAMA. 2006;295:318-323.

	Since this article does not have an abstract, we have provided the first 150 words of the full text and any section headings.

INTRODUCTION

DR DELBANCO: A 60-year-old unemployed widow, Ms A has felt sad much of her life. She graduated from high school, has 1 child, was married twice, and used to work as an aide in health care facilities. She lives in urban housing with her mother and has public insurance. For the past 30 years she has received care from a general internist practicing in an urban primary care practice.

Dating back to her first memories, Ms A recalls a troubled family life that may have included various forms of abuse. She was married and divorced in the 1970s; her daughter had some difficulty during her teens and early adulthood, but is doing well now and is close to the patient. Ms A first felt seriously depressed in her 20s. Over the years she tried alprazolam, sertraline, bupropion, diazepam, amitriptyline, nortriptyline, and . . . [Full Text of this Article]

MS A: HER VIEW

AT THE CROSSROADS: QUESTIONS FOR DR SALZMAN

Causes of TRD

Psychotic Depression

Medical Comorbidity

Substance Abuse, Personality Disorder, Posttraumatic Stress Disorder, and Other Psychiatric Comorbidity

Role of Cognitive Impairment and Neurological Illness

What Does the Future Hold?

Management of the Patient With TRD

Advice for Ms A and Her Physician

QUESTIONS AND DISCUSSION

AUTHOR INFORMATION

Author Affiliation: Dr Salzman is Professor of Psychiatry, Harvard Medical School, and Director of Education, Massachusetts Mental Health Center, Boston.

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