[Survey and treatment strategy of antidepressant-resistant depression]

The present study investigated the phenomenology and treatment of antidepressant-resistant depressions (ARD). To be classified a nonresponder, a patient had to have been treated adequately with two tricyclic (or tetracyclic) antidepressants (i.e., a minimum of the equivalent of 150 mg of imipramine for 4 weeks). The 34 depressed patients (25 unipolar patients and 9 bipolar patients) failed to respond to these antidepressant trials. Seventy-two % of the unipolar patients were in their first depression episodes, but 89% of the bipolar patients had 2 or more previous affective episodes. The mean duration of the current episode of depressions was 3.8 years. In 5 unipolar patients, the duration of the current depression episode was 10 years or more. The addition of lithium, bromocriptine or levothyroxine treatment to tricyclic or tetracyclic antidepressants were effective in the treatment of ARD. Levothyroxine were more effective in the treatment of the bipolar patients than the unipolar patients. Safrazine, a monoamine oxidase inhibitor, and electroconvulsive therapy were also effective in the treatment of ARD, but had the drawbacks of the high incidence of moderate or severe adverse reactions and high relapse rates, respectively. We propose a step-wise approach to the treatment of ARD, which mainly includes the pharmacotherapy and can be used in Japan.