scholarly journals A retrospective examination of care pathways in individuals with treatment-resistant depression

BJPsych Open ◽  
2021 ◽  
Vol 7 (3) ◽  
Author(s):  
Elana Day ◽  
Rupal Shah ◽  
Rachael W. Taylor ◽  
Lindsey Marwood ◽  
Kimberley Nortey ◽  
...  
Keyword(s):  
Depressive Episode ◽  
Burden Of Illness ◽  
Stepped Care ◽  
Adjunctive Treatment ◽  
Future Research ◽  
Care Pathways ◽  
Treatment Resistant Depression ◽  
Treatment Resistant ◽  
Treatment Gaps ◽  
Resistant Depression

Background Individuals with treatment-resistant depression (TRD) experience a high burden of illness. Current guidelines recommend a stepped care approach for treating depression, but the extent to which best-practice care pathways are adhered to is unclear. Aims To explore the extent and nature of ‘treatment gaps’ (non-adherence to stepped care pathways) experienced by a sample of patients with established TRD (non-response to two or more adequate treatments in the current depressive episode) across three cities in the UK. Method Five treatment gaps were considered and compared with guidelines, in a cross-sectional retrospective analysis: delay to receiving treatment, lack of access to psychological therapies, delays to medication changes, delays to adjunctive (pharmacological augmentation) treatment and lack of access to secondary care. We additionally explored participant characteristics associated with the extent of treatment gaps experienced. Results Of 178 patients with TRD, 47% had been in the current depressive episode for >1 year before initiating antidepressants; 53% had received adequate psychological therapy. A total of 47 and 51% had remained on an unsuccessful first and second antidepressant trial respectively for >16 weeks, and 24 and 27% for >1 year before medication switch, respectively. Further, 54% had tried three or more antidepressant medications within their episode, and only 11% had received adjunctive treatment. Conclusions There appears to be a considerable difference between treatment guidelines for depression and the reality of care received by people with TRD. Future research examining representative samples of patients could determine recommendations for optimising care pathways, and ultimately outcomes, for individuals with this illness.

scholarly journals Ketamine, Transcranial Magnetic Stimulation, and Depression Specific Yoga and Mindfulness Based Cognitive Therapy in Management of Treatment Resistant Depression: Review and Some Data on Efficacy

2015 ◽  
Vol 2015 ◽  
pp. 1-14 ◽  
Author(s):  
Basant Pradhan ◽  
Tapan Parikh ◽  
Ramkrishna Makani ◽  
Madhusmita Sahoo
Keyword(s):  
Transcranial Magnetic Stimulation ◽  
Cognitive Therapy ◽  
Magnetic Stimulation ◽  
Repetitive Transcranial Magnetic Stimulation ◽  
Pilot Trial ◽  
Adjunctive Treatment ◽  
Depression Symptoms ◽  
Treatment Resistant Depression ◽  
Treatment Resistant ◽  
Resistant Depression

Depression affects about 121 million people worldwide and prevalence of major depressive disorder (MDD) in US adults is 6.4%. Treatment resistant depression (TRD) accounts for approximately 12–20% of all depression patients and costs $29–$48 billion annually. Ketamine and repetitive transcranial magnetic stimulation (rTMS) have useful roles in TRD, but their utility in long term is unknown. As per the latest literature, the interventions using Yoga and meditation including the mindfulness based cognitive therapy (MBCT) have been useful in treatment of depression and relapse prevention. We present a review of rTMS, ketamine, and MBCT and also report efficacy of a depression specific, innovative, and translational model of Yoga and mindfulness based cognitive therapy (DepS Y-MBCT), developed by the first author.DepS Y-MBCTas an adjunctive treatment successfully ameliorated TRD symptoms in 27/32 patients in an open label pilot trial in TRD patients. Considering the limitations of existing treatment options, including those of ketamine and rTMS when used as the sole modality of treatment, we suggest a “tiered approach for TRD” by combining ketamine and rTMS (alone or along with antidepressants) for rapid remission of acute depression symptoms and to useDepS Y-MBCTfor maintaining remission and preventing relapse.

scholarly journals Antianhedonic Effect of Repeated Ketamine Infusions in Patients With Treatment Resistant Depression

2021 ◽  
Vol 12 ◽  
Author(s):  
Alina Wilkowska ◽  
Mariusz Stanisław Wiglusz ◽  
Maria Gałuszko-Wegielnik ◽  
Adam Włodarczyk ◽  
Wiesław Jerzy Cubała
Keyword(s):  
Depressive Symptoms ◽  
Depressive Episode ◽  
Controlled Trial ◽  
Self Report ◽  
Treatment Resistant Depression ◽  
Treatment Resistant ◽  
Antidepressive Effect ◽  
Resistant Depression ◽  
Depression Symptomatology

Anhedonia constitutes one of the main symptoms of depressive episode. It correlates with suicidality and significantly effects the quality of patient's lives. Available treatments are not sufficient against this group of symptoms. Ketamine is a novel, rapid acting strategy for treatment resistant depression. Here we report the change in symptoms of anhedonia measured by Snaith-Hamilton Pleasure Scale as an effect of eight ketamine infusions as an add-on treatment in 42 patients with treatment resistant depression. We also determined the effect of this change on the severity of depressive symptoms measured by Inventory for Depression Symptomatology-Self Report 30-Item (IDS-SR 30). We have observed statistically significant decrease in the level of anhedonia during ketamine treatment. After adjusting for potential confounders we have found that significant reduction in Snaith-Hamilton Pleasure Scale (SHAPS) after each infusion and 1 week post treatment was observed only among patients who did not use benzodiazepines. The reduction in symptoms of anhedonia mediates the antidepressive effect of ketamine. The results need replication in a larger randomized placebo controlled trial.

The Effects of Ketamine on Cognition in Treatment-Resistant Depression: A Systematic Review and Priority Avenues for Future Research

2021 ◽  
Vol 120 ◽  
pp. 78-85
Author(s):  
Hartej Gill ◽  
Barjot Gill ◽  
Nelson B. Rodrigues ◽  
Orly Lipsitz ◽  
Joshua Daniel Rosenblat ◽  
...  
Keyword(s):  
Systematic Review ◽  
Future Research ◽  
Treatment Resistant Depression ◽  
Treatment Resistant ◽  
Resistant Depression

Factors associated with response after deep transcranial magnetic stimulation in a real-world clinical setting: Results from the first 40 cases of treatment-resistant depression

2017 ◽  
Vol 44 ◽  
pp. 61-67 ◽  
Author(s):  
K. Feffer ◽  
K.A.B. Lapidus ◽  
Y. Braw ◽  
Y. Bloch ◽  
S. Kron ◽  
...  
Keyword(s):  
Depressive Symptoms ◽  
Transcranial Magnetic Stimulation ◽  
Clinical Global Impression ◽  
Real World ◽  
Depressive Episode ◽  
Magnetic Stimulation ◽  
Treatment Resistant Depression ◽  
Treatment Resistant ◽  
Resistant Depression ◽  
T1 And T2

AbstractBackground:Deep transcranial magnetic stimulation (dTMS) has been sanctioned by the United States Food and Drug Administration for treatment-resistant depression. In a retrospective cohort study, we evaluated response and effectiveness of dTMS in real-world practice, as an add-on treatment for resistant depression.Methods:Forty adult outpatients suffering from depression, all taking psychiatric medications, underwent 20 dTMS treatments over a 4–6 week period. At baseline (T0), visit 10 (T1), and visit 20 (T2), the Clinical Global Impression-Severity (CGI-S) scale was administered, and the Clinical Global Impression Improvement (CGI-I) scale was completed at T1 and T2; the Hamilton Depression Rating Scale (HDRS-21) was administrated at T0 and T2 only. The patients also completed the Quick Inventory of Depressive Symptoms–Self-Report (QIDS-SR) at T0, T1, and T2.Results:Depressive symptoms (HDRS-21 total score) decreased significantly following treatment. The HDRS total score decreased from an average of 21.22 (± 6.09) at T0, to 13.95 (± 7.24) at T2. Correspondingly, at T2, 32.5% were responders to the treatment and 20% were in remission, based on the HDRS-21. Treatment was well tolerated, with a discontinuation rate of 7.5%. While depressive symptoms at baseline did not predict remission/response at T2, higher HDRS scores at T0 were associated with a larger decrease in depressive symptoms during the study.Conclusions:Significant antidepressant effects were seen following 20 dTMS treatments, given as augmentation to ongoing medications in treatment-resistant depression. The findings suggest that among patients with TRD, the severity of the depressive episode (and not necessarily the number of failed antidepressant medication trials) is associated with a positive therapeutic effect of dTMS. Hence, the initial severity of the depressive episode may guide clinicians in referring patients for dTMS.

scholarly journals The Efficacy of Pramipexole, a Dopamine Receptor Agonist, as an Adjunctive Treatment in Treatment-Resistant Depression: An Open-Label Trial

2012 ◽  
Vol 2012 ◽  
pp. 1-8 ◽  
Author(s):  
Hiroaki Hori ◽  
Hiroshi Kunugi
Keyword(s):  
Rating Scale ◽  
Bipolar Depression ◽  
Care Facility ◽  
Adjunctive Treatment ◽  
Dopamine Receptor Agonist ◽  
Treatment Resistant Depression ◽  
Treatment Resistant ◽  
Major Depressive ◽  
Serious Adverse Events ◽  
Resistant Depression

Dopaminergic dysfunction is implicated in the pathophysiology of treatment-resistant depression. Although the efficacy of adjunctive pramipexole treatment has been demonstrated in treatment-resistant bipolar depression, such data are scarce for major depressive disorder (MDD). We recruited 17 patients with DSM-IV major depressive episode who have failed to respond to previous treatment with a selective serotonin reuptake inhibitor. Five patients were diagnosed as having bipolar II disorder and 12 as having unipolar MDD. Patients were monitored at an ambulatory care facility every two weeks until 12 weeks. Pramipexole was added to existing medication. Depression severity was assessed with the Hamilton Depression Rating Scale 21-item version (HDRS-21). The mean maximum dosage of pramipexole was 1.6 mg (SD 0.9). The HDRS-21 total score decreased from 19.4 (SD 3.8) at baseline to 7.2 (SD 5.4) at endpoint (P<0.000001). Twelve patients (71%) were responders based on the definition of 50% or more reduction in the HDRS-21 score. Ten patients (59%) remitted (HDRS-21 total score at endpoint<8). These results were almost unchanged when the sample was confined to patients with MDD. No serious adverse events were observed. Our findings indicate that pramipexole augmentation therapy may be effective and well tolerated in refractory depressed patients.

scholarly journals PMH19 BURDEN OF ILLNESS OF TREATMENT RESISTANT DEPRESSION

2010 ◽  
Vol 13 (7) ◽  
pp. A448-A449
Author(s):  
MM McInnis ◽  
MJ Halseth ◽  
P Cyr ◽  
RH Howland ◽  
Santiago L Bockstedt ◽  
...  
Keyword(s):  
Burden Of Illness ◽  
Treatment Resistant Depression ◽  
Treatment Resistant ◽  
Resistant Depression
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