Epidemiology of Treatment-Resistant Depression in the United States

This narrative review aims to provide an overview of the current literature on the pharmacology, safety, efficacy and tolerability of intranasal esketamine, the S-enantiomer of ketamine, for the treatment of treatment-resistant depression (TRD). A literature search using Medline, Embase, PsycINFO and Cochrane Central was conducted (January 2000 to July 2019). Product information and www.clinicaltrials.gov were also reviewed. The literature search was limited to human studies published in English. Phase I, II, and III studies of intranasal esketamine for TRD were reviewed. About a third of patients with major depressive disorder fail to achieve remission despite treatment with multiple antidepressants. This article examines the trials that led to the approval of esketamine in the United States, as well as other recent studies of esketamine for TRD. The findings from limited phase III trials illustrate that intranasal esketamine is effective and safe in reducing depressive symptoms and achieving clinical response in patients with TRD. The optimum duration and frequency of use are not fully understood. Although the nasal spray is a convenient dosage form, its use in practice may be limited by cost and administrative regulation. While it may prove beneficial to many patients who suffer from TRD, further long-term data are required, along with comparative trials with the R-isomer (arketamine). In the interim, care and monitoring should be exercised in its use in clinical practice.

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FDA Considers Classification of ECT

CNS Spectrums ◽

10.1017/s1092852900023920 ◽

2009 ◽

Vol 14 (12) ◽

pp. 668-670 ◽

Cited By ~ 1

Author(s):

S.H. Lisanby ◽

Stefano Pallanti ◽

Thomas E. Schlaepfer

Keyword(s):

Brain Stimulation ◽

The United States ◽

Treatment Resistant Depression ◽

Treatment Resistant ◽

United States Food ◽

Recent Developments ◽

States Food ◽

Resistant Depression ◽

Deep Brain

With the increasing number of new brain stimulation techniques now available and on the horizon, does electroconvulsive therapy (ECT) still have a role? As clinicians and researchers we say most definitely “yes”. ECT is the most effective and rapidly acting treatment for severe forms of depression and other disorders. Transcranial magnetic stimulation has shown promise but mainly for less severely ill and less treatment resistant patients. Deep brain stimulation (DBS) has shown promise for the more resistant cases but its invasiveness limits its use. Results from only ∼50 patients treated worldwide are available and at present it is not approved by the United States Food and Drug Administration for depression. Vagus nerve stimulation, less invasive than DBS but still a surgical procedure, is presently FDA approved for acute treatment resistant depression but published efficacy rates fall short of those seen with ECT. Therefore, there continues to be an important role for ECT in the treatment of severe psychiatric disorders. But will ECT always be there when our patients need it? Somewhat unexpected recent developments at the FDA may impact the future availability of ECT to severely depressed patients. Here we provide background on the classification of ECT devices, the FDA reclassification process, and the process for providing FDA input in these critical deliberations.

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Neuromodulation Intervention in Resistant Depression

Jurnal Psikiatri Surabaya ◽

10.20473/jps.v8i2.17136 ◽

2020 ◽

Vol 8 (2) ◽

pp. 39

Author(s):

Era Catur Prasetya ◽

Lestari Basoeki

Keyword(s):

Functional Disability ◽

Antidepressant Drugs ◽

The United States ◽

Treatment Resistant Depression ◽

Treatment Resistant ◽

Duration Of Treatment ◽

Non Invasive ◽

Disability Rate ◽

Resistant Depression ◽

Interventional Therapies

Treatment-resistant depression occurs in about 20% of all Major Deppresion Disorder patients. In addition to the high cost of treatment to be borne, the high functional disability rate, the suicide rate triggered by the disorder is also quite large. Various efforts were made to overcome this, including dose optimization and duration of treatment, substitution of drug selection, combination therapy and augmentation using non-antidepressant drugs and bilateral electroconvulsion therapy. Current pharmacological options according to some experts are no more efficacious than the 1950s. Clearly, a novel therapeutic approach to treatment - resistant depression disorders is urgently needed. Over the last few decades, there has been a renewed interest in focal neuromodulation as a treatment approach for neuropsychiatric conditions. The neuromodulation-based interventions discussed include Transcranial Magnetic Stimulation (TMS) and Transcranial Direct Current Stimulation (tDCS), which are non invasive intervention therapy and Vagus Nerve Stimulation (VNS) and Deep Brain Stimulation (DBS), which are invasive interventional therapies. This literature review proves that, although today only TMS and VNS have been approved for use by the Food and Drug Administration (FDA) in the United States, but neuromodilation-based intervention therapy has proven to be promising as a more effective and efficient resistant depression therapy in the future.

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