I received a call a few months ago from a non-psychiatric physician in our hospital asking questions regarding my thoughts on treating one of his patients. The physician was very frustrated that the treatments he was prescribing was not working. We discussed the treatments the patient has been on and has failed over the course of several years. He diagnosed the patient with major depression and ADHD. He had the patient on ADHD medications as well as antidepressants over the course of those several years. I reviewed the records and met with the patient and discussed his symptoms. I was able to meet with his girlfriend to obtain her viewpoint as well.
I reviewed the DSM criteria and discussed the possibility the patient had bipolar disorder with mixed features. The physician agreed and his treatment was changed. I have since spoken with both the physician and the patient and it seems the patient is doing much better with his new therapeutic plan.
The first question I asked the provider was, "How long did the you trial each medication before determining he had a failure to treatment"? Why is this an important factor based on the information you read this week?