Therapy of Treatment Resistant Depression: Focus on the Management of TRD with Atypical Antipsychotics

CNS Spectrums ◽  
2004 ◽  
Vol 9 (11) ◽  
pp. 823-832 ◽  
Author(s):  
Nikolas Klein ◽  
Julia Sacher ◽  
Helene Wallner ◽  
Johannes Tauscher ◽  
Siegfried Kasper
Keyword(s):  
Atypical Antipsychotics ◽  
Symptom Improvement ◽  
Treatment Resistant Depression ◽  
Treatment Resistant ◽  
Major Depressive ◽  
Adequate Treatment ◽  
Resistant Depression ◽  
Operational Criteria ◽  
Definition Of ◽  
Diagnosis Criteria

ABSTRACTTreatment-resistant depression (TRD) represents a significant challenge for physicians. About one third of patients with major depressive disorder fail to experience sufficient symptom improvement despite adequate treatment. Despite this high occurrence of TRD there was no general consensus on diagnosis criteria for TRD until 1997 when researchers proposed a model of defining and staging TRD. In 1999, others defined operational criteria for the definition of TRD. Treatment of TRD is commonly separated into pharmacologic and nonpharmacologic methods. This review gives a short overview of these two methods. The nonpharmacologic methods include psychotherapy, electroconvulsive therapy, and vagus nerve stimulation. Pharmacologic methods include switching to another antidepressant monotherapy, and augmentation or combination with two or more antidepressants or other agents. This review especially focuses on the augmentation of the antidepressant therapy with atypical antipsychotics.

scholarly journals A Delphi-method-based consensus guideline for definition of treatment-resistant depression for clinical trials

2021 ◽  
Author(s):  
Luca Sforzini ◽  
Courtney Worrell ◽  
Melisa Kose ◽  
Ian M. Anderson ◽  
Bruno Aouizerate ◽  
...  
Keyword(s):  
Clinical Trials ◽  
Lived Experience ◽  
Delphi Method ◽  
Treatment Resistant Depression ◽  
Treatment Resistant ◽  
Regulatory Bodies ◽  
Resistant Depression ◽  
Operational Criteria ◽  
Definition Of ◽  
International Experts

AbstractCriteria for treatment-resistant depression (TRD) and partially responsive depression (PRD) as subtypes of major depressive disorder (MDD) are not unequivocally defined. In the present document we used a Delphi-method-based consensus approach to define TRD and PRD and to serve as operational criteria for future clinical studies, especially if conducted for regulatory purposes. We reviewed the literature and brought together a group of international experts (including clinicians, academics, researchers, employees of pharmaceutical companies, regulatory bodies representatives, and one person with lived experience) to evaluate the state-of-the-art and main controversies regarding the current classification. We then provided recommendations on how to design clinical trials, and on how to guide research in unmet needs and knowledge gaps. This report will feed into one of the main objectives of the EUropean Patient-cEntric clinicAl tRial pLatforms, Innovative Medicines Initiative (EU-PEARL, IMI) MDD project, to design a protocol for platform trials of new medications for TRD/PRD.

Depression

2018 ◽  
Author(s):  
Raymond W. Lam
Keyword(s):  
Depressive Disorders ◽  
Special Populations ◽  
Treatment Resistant Depression ◽  
Treatment Resistant ◽  
Major Depressive ◽  
Basic Principles ◽  
Medically Ill ◽  
Dsm 5 ◽  
Resistant Depression

Depression, Third Edition provides a succinct clinical guide for the recognition, diagnosis, management, and modalities of treatment of depressive disorders. This new edition includes the DSM-5 diagnostic criteria, updates the latest neurobiological and psychological findings, and summarizes the Canadian Network for Mood and Anxiety Treatments (CANMAT) 2016 Clinical Guidelines for the Management of Adults with Major Depressive Disorder. The initial chapters deal with the epidemiology, pathogenesis, clinical features, and diagnosis of depression. Basic principles of clinical management are provided, as well as individual chapters dealing with the spectrum of available treatments for depression, including pharmacological, psychological, somatic, and complementary medicine approaches. A final chapter focuses on treatment-resistant depression (TRD) and other special populations including peripartum, elderly and medically ill, and children and adolescents.

scholarly journals Resistant depression: criteria for determination, risk factors and therapeutic strategies

2017 ◽  
Vol 2 (3) ◽  
pp. 020338
Author(s):  
Olena Khaustova
Keyword(s):  
Risk Factors ◽  
Atypical Antipsychotics ◽  
Therapeutic Response ◽  
Therapeutic Strategies ◽  
Treatment Resistant Depression ◽  
Treatment Resistant ◽  
Duration Of Treatment ◽  
Resistance To Treatment ◽  
Step Model ◽  
Resistant Depression

Background Therapy of resistant depression raises a number of diagnostic and therapeutic problems, requires the solution of a number of methodological issues. A scientific discussion continues around the definition of depression resistance, assessment of the degree of reduction of depressive symptoms, the level of social and role functioning of patients; the improvement of models for determining the degree of resistance to various types of depression therapy continues; new methods of therapy and new algorithms of combined therapy are being developed. The ultimate goal of all these efforts should be practical recommendations for determining therapeutic options for the treatment of patients with resistant depression, which will help doctors make informed decisions on intervention strategies. Aim To analyze the therapeutic possibilities of treating depressive disorders that are resistant to therapy. Methods Publications from the Pubmed, MEDLINE, the Cochrane Library, Web of Science, Google Scholar databases were analyzed. Tags: depression, treatment, resistance, psevdoresistence, therapeutic response, resistance to treatment, strategies for treatment of resistant depression. Results The terminology related to resistant depression was defined: lack of a therapeutic response, adequate dose, adequate duration of treatment, antidepressant intolerance, pseudo-resistance, relative resistance to treatment, absolute resistance to treatment, treatment of resistant depression, remission, recovery. Models for determining the resistance of depression have been described: the Thase & Rush model; European stepped model; A step model of the Massachusetts hospital; Step model of Maudsley; Form of the history of treatment with antidepressants. Risk factors for treatment of resistant depression were identified, and the main therapeutic strategies were described: optimization, switching, augmentation, combination and non-drug therapy. Particular attention is paid to the use of atypical antipsychotics, in particular arapiprazole, as the augmentation strategy. A complex approach is described, which includes various combinations of the above strategies. Conclusion Each case of treatment-resistant depression has its own unique characteristics and requires careful evaluation to determine the correct diagnosis and the quality of the therapeutic response. Equally important for building an adequate treatment plan is evaluating risk factors for the treatment of resistant depression. There is a wide variety of options for the treatment of resistant depression, so each therapeutic strategy should be used to help patients with treatment-resistant depression. The combination of antidepressant therapy and atypical antipsychotics with antidepressant properties in combination with psychotherapeutic intervention and adherence to adequate doses and duration of treatment may be a choice strategy for patients with treatment-resistant depression.

scholarly journals Esketamine in Treatment Resistant Depression: The Way to Remission

2021 ◽  
pp. 35-39
Author(s):  
João Facucho-Oliveira ◽  
Daniel Esteves-Sousa ◽  
Bruno Prates ◽  
Rui Neves ◽  
Pedro Varandas
Keyword(s):  
Depressive Symptoms ◽  
Behavioral Therapy ◽  
Symptomatic Relief ◽  
European Medicines Agency ◽  
Caucasian Woman ◽  
Treatment Resistant Depression ◽  
Treatment Resistant ◽  
Major Depressive ◽  
Aspartate Receptor ◽  
Resistant Depression

Major depressive disorder affects an estimate of 5% of the population with nearly 1‑third of patients failing to achieve remission with conventional pharmacological treatment. Esketamine, a novel rapid‑acting antidepressant, with a noncompetitive antagonism on N‑methyl‑D‑Aspartate receptor, have been recently approved by Food and Drug Administration (FDA) and European Medicines Agency (EMA) for treatment‑resistant depression. Here, we report a clinical case of a 42‑year‑old Caucasian woman who endured many years with severe depressive symptoms and high functional impairment. Previous treatments included cognitive behavioral therapy, numerous pharmacological trials with antidepressants and augmentation agents, and neurostimulation approaches. Upon treatment with esketamine, the patient presented remarkable clinical recovery. Psychometric assessments determined an acute reduction on the MADRS score after 1 week and progressive recovery of the depressive symptoms on the following weeks. Likewise, PHQ‑9 scale assessments, evaluating the relative frequency of depressive symptoms. and the Sheehan scale, assessing functional recovery, also determined a pronounced symptomatic relief.

scholarly journals Treatment-Resistant Depression in a Real-World Setting: First Interim Analysis of Characteristics, Healthcare Resource Use, and Utility Values of the FondaMental Cohort

2020 ◽  
Vol 10 (12) ◽  
pp. 962
Author(s):  
Antoine Yrondi ◽  
Djamila Bennabi ◽  
Emmanuel Haffen ◽  
Delphine Quelard ◽  
Ludovic Samalin ◽  
...  
Keyword(s):  
Resource Use ◽  
Healthcare Resource ◽  
The Other ◽  
Health State ◽  
Treatment Resistant Depression ◽  
Healthcare Resource Use ◽  
Treatment Resistant ◽  
Utility Value ◽  
Major Depressive ◽  
Resistant Depression

Background: Major depressive disorder (MDD) is among the most common psychiatric disorders. One-third of patients are usually unresponsive to several lines of treatment. This study aimed to describe the FondaMental French cohort of patients with treatment-resistant depression (TRD) and to estimate utility and healthcare resource use outcomes. Methods: Patients with TRD were evaluated prospectively over four years (baseline, 6, 12, 18, 24, 36 and 48 months) in a real-world clinical setting. Interim analyses focused on the first two consecutive years. Four MDD-related states (major depressive episode (MDE), response, remission, recovery) were defined based on the MADRS (Montgomery–Åsberg depression rating scale) and other clinical events. Health status was assessed with the EuroQol 5 Dimensions 5 Level (EQ-5D-5L) questionnaire. Utility values were estimated as preference measures that the patients assigned to their overall health status. Results: This study was based on 252 patients with TRD. The mean utility value by health state was 0.41, 0.63, 0.80, and 0.90, for MDE, response, remission, and recovery, respectively. At baseline, 59% of patients had an MADRS score of at least 28. Their baseline average utility value was lower compared to the other patients (0.43 versus 0.58, p < 0.001). This significant difference persisted at the following visits. The rate of patients in MDEs having at least one hospitalisation for depression or other reasons than depression was generally higher than that in the other health states. Conclusion: This study documented patterns in healthcare resource consumption, quality of life, and other characteristics in patients with TRD, both globally and by health state and depression severity.

Augmentation with Atypical Antipsychotics for Treatment-Resistant Depression

2021 ◽  
Vol 280 ◽  
pp. 45-53
Author(s):  
Filippo Cantù ◽  
Valentina Ciappolino ◽  
Paolo Enrico ◽  
Chiara Moltrasio ◽  
Giuseppe Delvecchio ◽  
...  
Keyword(s):  
Atypical Antipsychotics ◽  
Treatment Resistant Depression ◽  
Treatment Resistant ◽  
Resistant Depression
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