[Treatment of drug-resistant depression by intravenous administration of antidepressants]

The proportion of depressed patients no longer responding adequately to oral antidepressive medication combined with psychotherapy now amounts to as much as 15%. Depressive states failing to lift in response to antidepressants are referred to in Europe as "therapy-resistant". Before initiating some further form of treatment in a case of therapy resistance the diagnosis as well as the antidepressive treatment given hitherto (dosage, activity profile, compliance) should be reappraised. Where the diagnosis of "therapy-resistant depression" is confirmed, intravenous infusions of antidepressants in combination with psychotherapy have been found to offer the best prospects of success. With the help of daily infusions of maprotiline (ludiomil) and/or clomipramine (anafranil) it proved possible in over 1,000 patients suffering from therapy-resistant depression to achieve a remission in 60% and a marked improvement in 20%. At various research centres in Europe where intravenous drip infusions were administered in relatively low dosages, a more rapid onset of action was observed with fewer side effects, as well as higher plasma concentrations (thanks to avoidance of the first-pass effect) and no problems with respect to compliance.