Clinical and Demographic Characteristics and Bipolarity Features in Treatment-resistant Depression - Preliminary Results from Polish TRES-DEP Study

2009 ◽  
Vol 24 (S1) ◽  
pp. 1-1
Author(s):  
D. Dudek ◽  
M. Siwek ◽  
T. Pawłowski ◽  
J. Borowiecka-Kluza ◽  
A. Kiejna ◽  
...  
Keyword(s):  
Antidepressant Treatment ◽  
Mood Stabilizers ◽  
Treatment Resistant Depression ◽  
Treatment Resistant ◽  
Preliminary Results ◽  
Depression Group ◽  
Resistant Depression ◽  
Group 2 ◽  
Depressive Episodes ◽  
Group 1

Aim:The Polish multicenter Treatment Resistant Depression Project (TRES-DEP) has aimed to study a number of demographic, clinical and psychometric characteristics comparing patients with treatment-resistant (TR) and treatment non-resistant depression (TNR). Fifty patients with TR depression (group 1) and 50 patients with TNR depression (group 2) were included in this preliminary analysis.Method:Treatment-resistant depression was recognized on account of lack of significant improvement following at least two adequate courses of antidepressant treatment. The exclusion criteria were treatment with mood stabilizers, diagnosis of substance misuse, dementia or severe somatic disease. The presence of bipolarity features was assessed by Polish version of Mood Disorder Questionnaire (MDQ).Results:Significantly more patients with TR depression compared with TNR had family history of mental disorders, especially alcohol dependence (24% vs 8%, p=0,03), had more previous depressive episodes (8.5±5.0 vs 5.1±3.8; p=0.001), and reported shorter time from the last hospitalization (14.8±26.5 vs 41.9±71.1 months, p< 0.005). Patients from group 1 significantly more frequently fulfilled MDQ criteria for bipolarity than patients from group 2 (44% vs 12%, p< 0.001). Among TR patients, MDQ-positive compared with MDQ-negative more frequently reported treatment nonadherence (41% vs 18%, p=0.055), suicidal attempts (41% vs 18%, p=0.055) and inadequate remission (100% vs 21%; p< 0.05).Conclusion:Our preliminary results point to clinical differences between patients with TR and TNR depression, including higher scores on bipolarity scale in TR. The features of bipolarity may be an important reason for non-response during antidepressant treatment of depression and worse clinical course and outcome.

scholarly journals Use of 30-Hz Accelerated iTBS in Drug-Resistant Unipolar and Bipolar Depression in a Public Healthcare Setting: A Case Series

2022 ◽  
Vol 12 ◽  
Author(s):  
Filippo Cantù ◽  
Giandomenico Schiena ◽  
Domenico Sciortino ◽  
Lorena Di Consoli ◽  
Giuseppe Delvecchio ◽  
...  
Keyword(s):  
Rating Scale ◽  
Bipolar Depression ◽  
Case Series ◽  
Healthcare Setting ◽  
Public Healthcare ◽  
Treatment Resistant Depression ◽  
Treatment Resistant ◽  
Resistant Depression ◽  
Depressive Episodes ◽  
Hamilton Rating Scale

Background: Depressive episodes, especially when resistant to pharmacotherapy, are a hard challenge to face for clinicians and a leading cause of disability worldwide. Neuromodulation has emerged as a potential therapeutic option for treatment-resistant depression (TRD), in particular transcranial magnetic stimulation (TMS). In this article, we present a case series of six patients who received TMS with an accelerated intermittent theta-burst stimulation (iTBS) protocol in a public healthcare setting.Methods: We enrolled a total number of six participants, affected by a treatment-resistant depressive episode, in either Major Depressive Disorder (MDD) or Bipolar Disorder (BD). Patients underwent an accelerated iTBS protocol, targeted to the left dorsolateral prefrontal cortex (DLPFC), 3-week-long, with a total of 6 days of overall stimulation. On each stimulation day, the participants received 3 iTBS sessions, with a 15-min pause between them. Patients were assessed by the Hamilton Rating Scale for Depression (HAM-D), the Montgomery-Asberg Depression Rating Scale (MADRS), the Hamilton Rating Scale for Anxiety (HAM-A), and the Mania Rating Scale (MRS). At baseline (T0), at the end of the second week (T1), and at the end of the cycle of stimulation (T2).Results: The rANOVA (repeated Analysis of Variance) statistics showed no significant effect of time on the rating scale scores, with a slight decrease in MADRS scores and a very slight increase in HAM-A and HAM-D scores. No manic symptoms emerged during the entire protocol.Conclusions: Although accelerated iTBS might be considered a less time-consuming strategy for TMS administration, useful in a public healthcare setting, our results in a real-word six-patient population with TRD did not show a significant effect. Further studies on wider samples are needed to fully elucidate the potential of accelerated iTBS protocols in treatment-resistant depression.

scholarly journals Efficacy of repetitive transcranial magnetic stimulation in treatment-resistant depression: the evidence thus far

2019 ◽  
Vol 32 (4) ◽  
pp. e100074 ◽  
Author(s):  
Aditya Somani ◽  
Sujita Kumar Kar
Keyword(s):  
Transcranial Magnetic Stimulation ◽  
Electroconvulsive Therapy ◽  
Magnetic Stimulation ◽  
Antidepressant Treatment ◽  
Repetitive Transcranial Magnetic Stimulation ◽  
Common Mental Disorder ◽  
Treatment Resistant Depression ◽  
Treatment Resistant ◽  
Number Of Patients ◽  
Resistant Depression

Depression is a common mental disorder, which attributes to significant morbidity, disability and burden of care. A significant number of patients with depression still remain symptomatic after adequate trials of antidepressant treatment as well as psychotherapy, which is often referred to as treatment-resistant depression. Neuromodulation techniques—like electroconvulsive therapy, vagus nerve stimulation, transcranial magnetic stimulation (TMS) and transcranial direct current stimulation, may be useful augmenting techniques in depression, mostly recommended for treatment-resistant cases. Robust evidence exists regarding the efficacy of electroconvulsive therapy in the management of treatment-resistant depression; however, other techniques are understudied. TMS has been increasingly studied in various psychiatric disorders including depression. It has been approved by the US Food and Drug Administration for use in major depressive disorder. Over the past two decades, TMS has been studied in diverse groups of the population with depression using several research designs. This article gives an overview of the efficacy of repetitive TMS in treatment-resistant depression with the recent evidence.

Therapeutic Strategies for Treatment-resistant Depression: State of the Art and Future Perspectives

2020 ◽  
Vol 26 (2) ◽  
pp. 244-252
Author(s):  
Kah K. Goh ◽  
Shen-Chieh Chang ◽  
Chun-Hsin Chen ◽  
Mong-Liang Lu
Keyword(s):  
Antidepressant Treatment ◽  
Repetitive Transcranial Magnetic Stimulation ◽  
Treatment Options ◽  
Therapeutic Strategies ◽  
Evidence Based ◽  
Inadequate Response ◽  
Treatment Resistant Depression ◽  
Treatment Resistant ◽  
Treatment Choices ◽  
Resistant Depression

In this narrative review, we intended to summarize the evidence of pharmacological and somatic treatment choices for treatment-resistant depression (TRD). There are several types of therapeutic strategies to improve inadequate response to antidepressant treatment. The first step for patients with TRD is to optimize the dosage and duration of antidepressants as well as to ensure their drug compliance. The shift to antidepressant and antidepressant combination therapy for patients with TRD cannot be regarded as an evidence-based strategy. Only the combination of a monoamine reuptake inhibitor with a presynaptic α2-autoreceptor antagonist might have better efficacy than other antidepressant combinations. Currently, the most evidence-based treatment options for TRD are augmentation strategies. Among augmentative agents, second-generation antipsychotics and lithium have the strongest evidence for the management of TRD. Further studies are needed to evaluate the augmentative efficacy of anticonvulsants, thyroid hormone, glutamatergic agents, anti-inflammatory agents, and nutraceuticals for TRD. Among somatic therapies, electroconvulsive therapy and repetitive transcranial magnetic stimulation are effective for TRD. Further studies are warranted to provide clinicians with a better recommendation in making treatment choices in patients with TRD.

scholarly journals Transcranial pulsed electromagnetic fields for treatment-resistant depression: A multicenter 8-week single-arm cohort study

2020 ◽  
Vol 63 (1) ◽  
Author(s):  
Erik Roj Larsen ◽  
Rasmus W. Licht ◽  
René Ernst Nielsen ◽  
Annette Lolk ◽  
Bille Borck ◽  
...  
Keyword(s):  
Cohort Study ◽  
Antidepressant Treatment ◽  
Treatment Options ◽  
Depression Scale ◽  
Antidepressant Effect ◽  
Hamilton Depression Scale ◽  
Treatment Resistant Depression ◽  
Treatment Resistant ◽  
Resistant Depression ◽  
Pulsed Electromagnetic

Abstract Background. The efficacy of antidepressant treatment is fair, but the efficacy is considerably lower in patients failing two or more trials underscoring the need for new treatment options. Our study evaluated the augmenting antidepressant effect of 8-weeks transcranial pulsed electromagnetic field (T-PEMF) therapy in patients with treatment-resistant depression. Methods. A multicenter 8-week single-arm cohort study conducted by the Danish University Antidepressant Group. Results. In total, 58 participants (20 men and 38 women) with a moderate to severe depression as part of a depressive disorder according to ICD-10 who fulfilled criteria for treatment resistance were included, with 19 participants being nonresponders to electroconvulsive therapy during the current depressive episode. Fifty-two participants completed the study period. Scores on the Hamilton Depression Scale 17-items version (HAM-D17) decreased significantly from baseline (mean = 20.6, SD 4.0) to endpoint (mean = 12.6, SD 7.1; N = 58). At endpoint, utilizing a Last Observation Carried Forward analysis, 49 and 28% of those participants with, respectively, a nonchronic current episode (≤2 years; N = 33) and a chronic current episode (>2 years; N = 25) were responders, that is, achieved a reduction of 50% or more on the HAM-D17 scale. At endpoint, respectively, 30 and 16% obtained remission, defined as HAM-D17 ≤ 7. On the Hamilton Scale 6-item version (HAM-D6), respectively, 51 and 16% obtained remission, defined as HAM-D6 ≤ 4. Conclusions. The findings indicate a potential beneficial role of T-PEMF therapy as an augmentation treatment to ongoing pharmacotherapy in treatment-resistant depression.

scholarly journals Central nervous system-related safety and tolerability of add-on ketamine to antidepressant medication in treatment-resistant depression: focus on the unique safety profile of bipolar depression

2021 ◽  
Vol 11 ◽  
pp. 204512532110110
Author(s):  
Adam Włodarczyk ◽  
Wiesław J. Cubała ◽  
Maria Gałuszko-Węgielnik ◽  
Joanna Szarmach
Keyword(s):  
Central Nervous System ◽  
Nervous System ◽  
Rating Scale ◽  
Bipolar Depression ◽  
Small Sample Size ◽  
Small Sample ◽  
Mood Stabilizers ◽  
Treatment Resistant Depression ◽  
Treatment Resistant ◽  
Resistant Depression

Background: There is evidence supporting the use of ketamine in treatment-resistant depression (TRD). However, there are some safety and tolerability concerns associated with ketamine. This study aimed to investigate ketamine’s safety and tolerability to the central nervous system and to assess the relationship between dissociative symptomology and psychometric outcomes during and after intravenous ketamine treatment concurrent with treatment by varying psychotropic medications in treatment-refractory inpatients with major depressive disorder (MDD) and bipolar disorder (BP). Methods: A total of 49 patients with MDD and BP were included in this study. The subjects were administered ketamine and were assessed for changes using an observational protocol. Results: No antidepressants were associated with psychomimetic symptomatology except for citalopram ( p = 0.019). Patients treated with citalopram showed a higher intensity of psychomimetic symptomatology. The use of classic mood-stabilizers was significantly associated with an increase in psychomimetic symptomatology according to the Brief Psychiatric Rating Scale (BPRS; lamotrigine p = 0.009, valproate p = 0.048, lithium p = 0.012). No sequelae were observed. Conclusions: Despite the limitations that this study may be underpowered due to the small sample size, the sample consisted of a heterogeneous TRD population in a single site, and there no blinding of who underwent only acute ketamine administration, our observations indicate ketamine use requires close safety and tolerability monitoring with regards to psychomimetic and dissociative symptoms in TRD-BP and careful management for MDD patients. ClinicalTrials.gov identifier: NCT04226963

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