scholarly journals Current perspectives in the management of treatment-resistant depression

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.

Multidisciplinary Treatments and Medications for Depressive Disorders and Comorbidity

2014 ◽  
Author(s):  
Robert H. Howland
Keyword(s):  
Depressive Disorders ◽  
Treatment Resistance ◽  
Chronic Depression ◽  
Care Utilization ◽  
Treatment Resistant ◽  
Medical Disorders ◽  
Treatment Of Depression ◽  
Increased Risk ◽  
Resistant Depression ◽  
Medical Morbidity

Compared with episodic depression, chronic depression and treatment resistant depression have higher rates of comorbidity, more persistent social and vocational disability, an increased risk of suicide, greater medical morbidity and mortality, and greater health care utilization and costs. A large number of antidepressant medications and other psychotropic drugs, depression-focused psychotherapies, and neuromodulation therapies are available for the treatment of depression. Many drugs or psychotherapies are used for the treatment of other psychiatric disorders or medical conditions, and they should be considered relevant when these comorbidities exist with depression. Selecting treatments for depression must take into account the clinical implications of the presence of any comorbidities. Because comorbidity is associated with depressive chronicity and treatment resistance, various approaches to treating chronic depression or TRD have been investigated. Treating depressed patients with comorbid psychiatric, personality, or medical disorders is a clinical challenge that requires effective multidisciplinary collaboration.

scholarly journals Treatment-Resistant Depression in Adolescents: Clinical Features and Measurement of Treatment Resistance

2020 ◽  
Vol 30 (4) ◽  
pp. 261-266 ◽  
Author(s):  
Jeffrey R. Strawn ◽  
Scott T. Aaronson ◽  
Ahmed Z. Elmaadawi ◽  
G. Randolph Schrodt ◽  
Richard C. Holbert ◽  
...  
Keyword(s):  
Clinical Features ◽  
Treatment Resistance ◽  
Treatment Resistant Depression ◽  
Treatment Resistant ◽  
Resistant Depression

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.

Treatments for Pediatric Depression

2015 ◽  
Author(s):  
Carolina Biernacki ◽  
Prerna Martin ◽  
Pablo H. Goldberg ◽  
Moira A. Rynn
Keyword(s):  
Positive Response ◽  
Behavioral Therapy ◽  
Antidepressant Medication ◽  
Psychosocial Interventions ◽  
Evidence Base ◽  
Treatment Resistant Depression ◽  
Treatment Resistant ◽  
Medication Treatment ◽  
Pediatric Depression ◽  
Resistant Depression

Practice guidelines recommend psychosocial interventions for mild or brief cases of pediatric depression. In moderate to severe cases, medication treatment is recommended, with or without cognitive-behavioral therapy (CBT). Fluoxetine and escitalopram are the only antidepressants approved by the U.S. Food & Drug Administration for acute pediatric depression. Among psychosocial interventions, CBT and interpersonal psychotherapy for adolescents (IPT-A) have the largest evidence base for treatment of depressed youth. Combination treatment with CBT and antidepressant medication is superior to treatment with either modality alone. In treatment-resistant depression, a switch in antidepressant is more likely to yield a positive response when medication is used with CBT. Antidepressants should be used judiciously in youths as higher rates of adverse events have been demonstrated, and data from adult trials cannot be systematically extrapolated to youths. Further studies are needed to assess alternative medication and psychosocial treatments as well as factors predictive of treatment response.

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 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.

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