Treatment-resistant depression: therapeutic options when first-line treatments fail

2021 ◽  
Vol 28 (1) ◽  
pp. 4-8
Author(s):  
Chloe Wigg ◽  
Sara Costi
Keyword(s):  
Antidepressant Treatment ◽  
Small Body ◽  
Cochrane Review ◽  
Treatment Resistant Depression ◽  
Long Term Effects ◽  
Treatment Resistant ◽  
Short Term ◽  
Augmentation Strategies ◽  
Resistant Depression

SUMMARYThe Cochrane review by Davies et al aimed to address the lack of clarity on the risks and benefits of switching and augmentation strategies in the pharmacological treatment of treatment-resistant depression in adults who did not respond (or partially responded) to at least 4 weeks of antidepressant treatment at a recommended dose. This commentary assesses their review and their conclusion that augmenting the current antidepressant with mianserin or with an antipsychotic improves depressive symptoms over the short-term (8 to 12 weeks). Their results need to be treated with caution owing to the small body of evidence and individual comparisons supported by one, two or three studies, the limited evidence on long-term effects and the significant gaps in the literature (e.g. a lack of studies assessing dose increases).

scholarly journals The Efficacy of Buprenorphine in Major Depression, Treatment-Resistant Depression and Suicidal Behavior: A Systematic Review

2018 ◽  
Vol 19 (8) ◽  
pp. 2410 ◽  
Author(s):  
Gianluca Serafini ◽  
Giulia Adavastro ◽  
Giovanna Canepa ◽  
Domenico De Berardis ◽  
Alessandro Valchera ◽  
...  
Keyword(s):  
Major Depression ◽  
Suicidal Behavior ◽  
Depression Treatment ◽  
Treatment Resistant Depression ◽  
Long Term Effects ◽  
Treatment Resistant ◽  
Refractory Depression ◽  
Research Findings ◽  
Resistant Depression

Although several pharmacological options to treat depression are currently available, approximately one third of patients who receive antidepressant medications do not respond adequately or achieve a complete remission. Thus, novel strategies are needed to successfully address those who did not respond, or partially respond, to available antidepressant pharmacotherapy. Research findings revealed that the opioid system is significantly involved in the regulation of mood and incentives salience and may be an appropriate target for novel therapeutic agents. The present study aimed to systematically review the current literature about the use of buprenorphine (BUP) for major depression, treatment-resistant depression (TRD), non-suicidal self-injury (NSSI) behavior, and suicidal behavior. We investigated Pubmed and Scopus databases using the following keywords: “buprenorphine AND depression”, “buprenorphine AND treatment resistant depression”, “buprenorphine AND suicid*”, “buprenorphine AND refractory depression”. Several evidence demonstrate that, at low doses, BUP is an efficacious, well-tolerated, and safe option in reducing depressive symptoms, serious suicidal ideation, and NSSI, even in patients with TRD. However, more studies are needed to evaluate the long-term effects, and relative efficacy of specific combinations (e.g., BUP + samidorphan (BUP/SAM), BUP + naloxone (BUP/NAL), BUP + naltrexone) over BUP monotherapy or adjunctive BUP treatment with standard antidepressants, as well as to obtain more uniform guidance about the optimal BUP dosing interval.

scholarly journals Long-Term Impact of Residual Symptoms in Treatment-Resistant Depression

2011 ◽  
Vol 56 (9) ◽  
pp. 549-557 ◽  
Author(s):  
Abebaw Fekadu ◽  
Sarah C Wooderson ◽  
Lena J Rane ◽  
Kalypso Markopoulou ◽  
Lucia Poon ◽  
...  
Keyword(s):  
Treatment Resistant Depression ◽  
Treatment Resistant ◽  
Residual Symptoms ◽  
Resistant Depression ◽  
Long Term Impact

scholarly journals Long-term deep brain stimulation of the ventral anterior limb of the internal capsule for treatment-resistant depression

2019 ◽  
Vol 91 (2) ◽  
pp. 189-195 ◽  
Author(s):  
Junus M. van der Wal ◽  
Isidoor O. Bergfeld ◽  
Anja Lok ◽  
Mariska Mantione ◽  
Martijn Figee ◽  
...  
Keyword(s):  
Rating Scale ◽  
Response Rate ◽  
Internal Capsule ◽  
Maintenance Phase ◽  
Efficacy And Safety ◽  
Treatment Resistant Depression ◽  
Treatment Resistant ◽  
Resistant Depression ◽  
Deep Brain

ObjectiveDeep brain stimulation (DBS) reduces depressive symptoms in approximately 40%–60% of patients with treatment-resistant depression (TRD), but data on long-term efficacy and safety are scarce. Our objective was to assess the efficacy and safety of DBS targeted at the ventral anterior limb of the internal capsule (vALIC) in 25 patients with TRD during a 1-year, open-label, maintenance period, which followed a 1-year optimisation period.MethodsDepression severity was measured using the 17-item Hamilton Depression Rating Scale (HAM-D-17), Montgomery-Asberg Depression Rating Scale (MADRS) and self-reported Inventory of Depressive Symptomatology (IDS-SR). Primary outcomes were response rate (≥50% HAM-D-17 score reduction) after the maintenance phase, approximately 2 years after DBS surgery, and changes in depression scores and occurrence of adverse events during the maintenance phase.ResultsOf 25 operated patients, 21 entered and 18 completed the maintenance phase. After the maintenance phase, eight patients were classified as responder (observed response rate: 44.4%; intention-to-treat: 32.0%). During the maintenance phase, HAM-D-17 and MADRS scores did not change, but the mean IDS-SR score decreased from 38.8 (95% CI 31.2 to 46.5) to 35.0 (95% CI 26.1 to 43.8) (p=0.008). Non-responders after optimisation did not improve during the maintenance phase. Four non-DBS-related serious adverse events occurred, including one suicide attempt.ConclusionsvALIC DBS for TRD showed continued efficacy 2 years after surgery, with symptoms remaining stable after optimisation as rated by clinicians and with patient ratings improving. This supports DBS as a viable treatment option for patients with TRD.Trial registration numberNTR2118.

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