Effective translational medicine requires ongoing dynamic, multidimensional clinical assessments of each patient that modify treatments as needed to effectively utilize new knowledge.

In psychiatry, 20%-60% of all cases are labeled "treatment resistant". Psychiatrists should view treatment failure as a stage from which eventual remission is expected rather than applying treatment resistant as an endpoint and unsanctioned diagnosis.

“Thinking about how we think” helps develop a logical progression of treatment options and increases our chances of success, rather than unconsciously submitting to the irrational distortions of probability that our minds are prone to rely on.

According to some estimates, about 20% to 60% of psychiatric diagnoses eventually become labeled “treatment resistant,” yet psychiatry seems to lack a consensus on what “treatment resistance” means, including clear criteria, H. Paul Putman III, MD, told Psychiatric Times in an exclusive interview.

The conceptual error we make is confusing treatment resistance with treatment failure. Relabeling a diagnosis as treatment resistant represents a failure of clinical problem-solving when second opinions identify remaining treatment options for more than two-thirds of these patients.

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Some clinicians wish to find ways to disseminate or support evidence-based information that can affect the health of their patients, but that may be mired in misinformation or heated controversy. Dr. Putman discusses suggestions from some experts.

Subspecialty psychiatry will no doubt continue to provide increasingly effective levels of care to patients, but Dr. Putman suggests the best practice may be approaching the diagnosis of every new patient as a generalist.

Bruce Bassi, MD, interviews Dr. Paul Putman about his recent book Rational Psychopharmacology: A Book of Clinical Skills, his upcoming book Encountering Treatment Resistance: Success Through Reconceptualization, and the use of metacognition to reduce errors and improve treatment outcomes.

Addressing recent discussion in the media regarding the role of serotonin in the treatment of depression, Dr. Putman clarifies that the most effective treatments are based on outcomes studies, not theory.