Clinical and Subclinical Hypothyroidism in Patients with Chronic and Treatment-Resistant Depression

Objective: To investigate the relationship between hypothyroidism and treatment-resistant depression (TRD). Method: A retrospective case audit of 93 inpatients of a specialist Mood Disorders Unit. Patients referred with TRD were sub-classified into ‘adequate’ or ‘inadequate’ prior treatment groups on the basis of pre-established criteria, and compared with a ‘non-TRD’ control sample. Grades I (clinical) and II (subclinical) hypothyroidism were determined by review of relevant thyroid indices. Results: Patients had chronic depressive disorders (sub-group means of 57.5-82.2 weeks of illness). Of those patients referred with TRD, 22% (10/46) had evidence of clinical or subclinical hypothyroidism compared with 2% (1/47) of the non-TRD patients (p < 0.01). A gradient in the rates of grade I hypothyroidism was observed with the adequately-treated TRD patients having the highest rate (13%), the inadequately-treated TRD patients having an intermediate rate (7%), and the non-TRD patients having the lowest rate (2%). Consistent with this view, the inadequately-treated TRD group had the highest rate of grade II hypothyroidism (p = 0.01) and tended to have higher thyroid stimulating hormone (TSH) values (p = 0.06). Differences in the rates of hypothyroidism could not be accounted for by differences in age or prior exposure to lithium and/or carbamazepine. Duration of the depressive episode was negatively correlated with both the free thyroxine indices (r = −0.25, P < 0.05) and TSH levels (r = −0.32, p < 0.01). Conclusions: This study suggests that relative hypothyroidism may play a role in the development of some treatment-resistant depressive disorders.

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Baseline Working Memory Predicted Response to Low-Dose Ketamine Infusion in Patients with Treatment-Resistant Depression

Pharmacopsychiatry ◽

10.1055/a-1589-6301 ◽

2021 ◽

Author(s):

Mu-Hong Chen ◽

Wei-Chen Lin ◽

Cheng-Ta Li ◽

Shih-Jen Tsai ◽

Hui-Ju Wu ◽

...

Keyword(s):

Working Memory ◽

Depressive Symptoms ◽

Treatment Response ◽

Low Dose ◽

Memory Function ◽

Treatment Resistant Depression ◽

Treatment Resistant ◽

Ketamine Infusion ◽

Treatment Groups ◽

Resistant Depression

Abstract Introduction Pretreatment neurocognitive function may predict the treatment response to low-dose ketamine infusion in patients with treatment-resistant depression (TRD). However, the association between working memory function at baseline and the antidepressant efficacy of ketamine infusion remains unclear. Methods A total of 71 patients with TRD were randomized to one of three treatment groups: 0.5 mg/kg ketamine, 0.2 mg/kg ketamine, or normal saline. Depressive symptoms were measured using the 17-item Hamilton Depression Rating Scale (HDRS) at baseline and after treatment. Cognitive function was evaluated using working memory and go-no-go tasks at baseline. Results A generalized linear model with adjustments for demographic characteristics, treatment groups, and total HDRS scores at baseline revealed only a significant effect of working memory function (correct responses and omissions) on the changes in depressive symptoms measured by HDRS at baseline (F=12.862, p<0.05). Correlation analysis further showed a negative relationship (r=0.519, p=0.027) between pretreatment working memory function and changes in HDRS scores in the 0.5 mg/kg ketamine group. Discussion An inverse relationship between pretreatment working memory function and treatment response to ketamine infusion may confirm that low-dose ketamine infusion is beneficial and should be reserved for patients with TRD.

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Depression

10.1093/med/9780198804147.001.0001 ◽

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.

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Venlafaxine and paroxetine in treatment-resistant depression

The British Journal of Psychiatry ◽

10.1192/bjp.175.1.12 ◽

1999 ◽

Vol 175 (1) ◽

pp. 12-16 ◽

Cited By ~ 138

Author(s):

M.-F. Poirier ◽

P. Boyer

Keyword(s):

Response Rate ◽

Treatment Resistant Depression ◽

Treatment Resistant ◽

Treatment Groups ◽

Antidepressant Treatments ◽

History Of ◽

Resistant Depression ◽

Effective Drugs ◽

Improvement Score ◽

Treat Patient

BackgroundAbout one-third of patients fail to respond to initial antidepressant therapy, which suggests a need for more effective drugs.AimsTo compare the efficacy and safety of venlafaxine and paroxetine in 122 patients with non-chronic treatment-resistant depression.MethodIn-patients or out-patients satisfying DSM – III – R criteria for major depression in evolution for less than eight months, having a baseline HAM–D score 18 and a HAM – D Item 3 score < 3 were eligible. Patients were required to have a history of resistance to two previous antidepressant treatments and a CGI improvement score of 3 at the beginning of treatment. Doses were adjusted to 200–300 mg/day for venlafaxine and 30–40 mg/day for paroxetine.ResultsFor the observed-case analysis, the response rate was 51.9% for venlafaxine and 32.7% for paroxetine (P=0.044), and a remission was achieved in 42.3% of venlafaxine-treated and 20.0% of paroxetine-treated patients (P=0.01). The incidence of adverse effects was comparable between treatment groups.ConclusionsVenlafaxine showed some evidence of superiority to paroxetine in this difficult-to-treat patient population.

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Current perspectives in the management of treatment-resistant depression

Dialogues in Clinical Neuroscience ◽

10.31887/dcns.2004.6.1/rparikh ◽

2004 ◽

Vol 6 (1) ◽

pp. 53-60

Keyword(s):

Depressive Disorders ◽

Antidepressant Treatment ◽

Behavioral Therapy ◽

Treatment Resistance ◽

Care Utilization ◽

Treatment Resistant Depression ◽

Treatment Resistant ◽

Combination Strategies ◽

Resistant Depression ◽

Definition Of

Depressive disorders are a leading cause of disability worldwide and greatly impact morbidity, health care utilization, and medical costs. Major depression that does not resolve with adequate antidepressant treatment is termed treatment-resistant depression (TRD), There is no universally accepted definition of TRD and several criteria have been suggested to define it. Multiple factors can contribute to treatment resistance, including unrecognized comorbid medical or psychiatric illness, the use of concomitant medications, noncompliance, and psychosocial stressors. TRD is associated with extensive use of depression-related and general medical services, and poses a substantial economic burden. Current approaches to its management include the use of antidepressant strategies, such as increasing the dose of the antidepressant, augmentation strategies, combination strategies, and switching strategies, electroconvulsive therapy, and cognitive behavioral therapy. Although no definite algorithm exists for treating TRD, research in this area has advanced considerably in recent years. One approach to this is a clinical trial called STAR*D (Sequenced Treatment Alternatives to Relieve Depression). This has the potential to increase our understanding about the diagnostic and therapeutic aspects of TRD, to substantially reduce disability, and to enhance the quality of life in individuals with this condition.

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