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How treatable is refractory depression?

Jonathan W Stewart1, Deborah A Deliyannides1, Patrick J McGrath1

  • 1New York State Psychiatric Institute, USA; Columbia University College of Physicians and Surgeons, New York, NY, USA.

Journal of Affective Disorders
|June 28, 2014
PubMed
Summary
This summary is machine-generated.

Many patients with treatment-resistant depression can still achieve remission with further treatment. This study shows that refractory depression is often temporary, with many patients maintaining remission long-term.

Keywords:
DextroamphetamineLithiumNortriptylinePhenelzineRefractory depressionTranylcypromine

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Area of Science:

  • Neuroscience
  • Psychiatry
  • Clinical Pharmacology

Background:

  • Treatment-resistant depression poses a significant clinical challenge, leading to prolonged patient suffering and disability.
  • Limited knowledge exists regarding the likelihood of eventual remission and effective treatment strategies for non-remitting patients.

Purpose of the Study:

  • To investigate the efficacy of sequential treatment augmentation strategies in patients with major depression refractory to multiple antidepressant trials.
  • To determine the remission rates and long-term maintenance of remission in this patient population.

Main Methods:

  • A cohort of 28 patients with major depression, non-remitted after adequate trials of at least two different antidepressants, were enrolled.
  • Sequential treatment phases included tranylcypromine (up to 120 mg/d) with dextroamphetamine augmentation, followed by nortriptyline plus lithium, and then phenelzine augmentation.
  • Remission was assessed at each phase, with subsequent phases initiated only if remission was not achieved.

Main Results:

  • Overall, 18 of 28 patients (65%) achieved remission during the study, with an additional 5 patients (82% total) remitting with open post-study treatment.
  • Remission rates varied by phase: tranylcypromine (up to 60 mg/d) yielded 30% remission, augmentation to 120 mg/d yielded 33%, and dextroamphetamine addition yielded 17%.
  • Subsequent phases showed 10% remission with nortriptyline+lithium and 20% with phenelzine addition. 64% of remitted patients maintained remission for at least six months.

Conclusions:

  • A majority of patients with depression refractory to multiple antidepressant treatments can achieve remission.
  • Approximately half of the patients who remit may maintain their remission for extended periods.
  • "Refractory depression" may be a relative state, suggesting potential for recovery in many seemingly unresponsive individuals.