Patients with treatment-resistant depression (TRD) are both interesting and challenging to manage.1
It is easy to overlook other possible causes for TRD including autism, both diagnosed and undiagnosed. Autistic cognition differs from neurotypical cognition.
Autism can be difficult to identify in women, black and minority ethnic groups, older people, and individuals with diagnoses of attention deficit hyperactivity disorder, obsessive compulsive disorder, and learning disabilities.2,3
It is well recognised that autistic individuals are at significantly higher risk of diagnostic overshadowing.3,4 This typically manifests itself when a clinician informs an autistic individual with depression that their depressive symptoms are due to their autism, even though this attribution may be partially or completely inappropriate. Equally, the reverse can apply when an autistic individual is diagnosed with depression, when their autistic cognition would explain most of their symptoms.
It would be excellent if all trials, systematic reviews, and meta-analyses about TRD and associated topics were more explicit about how autism, both diagnosed and undiagnosed, and any associated diagnostic overshadowing are taken into consideration.
Clinicians need to be mindful of the possibility of undiagnosed autism in all patients with TRD, including those receiving cognitive behavioural therapy.
Competing interests
Michael J White has an adult son with autism.
REFERENCES
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