Treatment options for refractory depression
by
Shelton RC.
Department of Psychiatry,
Vanderbilt University School of Medicine,
Nashville, Tenn 37212, USA.
RICHARD.SHELTON@MCMAIL.VANDERBILT.EDU.
J Clin Psychiatry 1999;60 Suppl 4:57-61; discussion 62-39


ABSTRACT

A significant proportion of patients with depressive disorders do not experience a full response with antidepressant treatment. Fortunately, most eventually remit, even though the time to response may be significantly delayed in many patients. A variety of options exist to deal with these difficult clinical situations. Established strategies include switching to an antidepressant of an alternative class (e.g., tricyclic to a monoamine oxidase inhibitor [MAOI] or selective serotonin reuptake inhibitor [SSRI]), electroconvulsive therapy (ECT), and augmentation with lithium or thyroid hormone. Promising alternatives include combined serotonin and norepinephrine enhancement strategies (e.g., SSRI plus serotonin norepinephrine reuptake inhibitor [NSRI] or higher doses of venlafaxine or fluoxetine), steroid suppression therapy, augmentation with atypical antipsychotics, and psychotherapy.
Antidepressants
Mixed depression
Chronic depression
Atypical depression
Retarded depression
New antidepressants
How heritable is depression?
Treatment-resistant depression
The monoamine theory of depression
Early-onset antidepressant strategies
Treatment-resistant depression; new therapies
Catecholamine function and refractory depression
Somatic symptoms in treatment-resistant depression


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