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Related Experiment Videos

Treatment options for refractory depression.

R C Shelton1

  • 1Department of Psychiatry, Vanderbilt University School of Medicine, Nashville, Tenn 37212, USA. RICHARD.SHELTON@MCMAIL.VANDERBILT.EDU

The Journal of Clinical Psychiatry
|March 23, 1999
PubMed
Summary
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Many patients with depression do not fully respond to initial antidepressant treatment. Established and novel strategies, including medication changes, electroconvulsive therapy, and psychotherapy, can help achieve remission.

Area of Science:

  • Neuroscience
  • Psychiatry
  • Pharmacology

Background:

  • A significant number of patients with depressive disorders exhibit an incomplete response to standard antidepressant therapies.
  • While most patients eventually achieve remission, the onset of response can be substantially delayed.

Purpose of the Study:

  • To review established and emerging treatment strategies for patients with treatment-resistant depression.
  • To provide an overview of options for managing patients who do not achieve a full response to initial antidepressant treatment.

Main Methods:

  • Literature review of established and promising treatment options for antidepressant non-responders.
  • Categorization of strategies into established (e.g., switching antidepressants, ECT, augmentation) and alternative (e.g., combined neurotransmitter enhancement, steroid suppression, atypical antipsychotics, psychotherapy).

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Main Results:

  • Established strategies include switching antidepressant classes (e.g., tricyclic to monoamine oxidase inhibitor [MAOI] or selective serotonin reuptake inhibitor [SSRI]), electroconvulsive therapy (ECT), and augmentation with lithium or thyroid hormone.
  • Promising alternative strategies involve combined serotonin and norepinephrine enhancement, steroid suppression, augmentation with atypical antipsychotics, and psychotherapy.

Conclusions:

  • A range of therapeutic options are available for patients with depressive disorders who do not respond fully to initial antidepressant treatment.
  • These options include both established interventions and novel approaches, offering pathways to achieve remission in difficult-to-treat cases.