A Description of Next-Step Switching Versus Augmentation Practices for Outpatients with Treatment-Resistant Major Depressive Disorder Enrolled in an Academic Specialty Clinic

Papakostas, George I.; Petersen, Timothy; Green, Cassandra; Iosifescu, Dan V.; Yeung, Albert; Nierenberg, Andrew A.; Fava, Maurizio; Posternak, Michael A.

doi:10.1080/10401230591002129

Cited by 13 publications

(7 citation statements)

References 15 publications

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“…However, no supporting data are available regarding the superiority of one strategy over other treatment options. As was seen in surveys with clinicians and treatment choice in the STAR*D trial, augmentation is potentially favoured in partial responders [17][18][19][20][21][22]. This is primarily based on practical considerations, namely that the addition of a second agent allows the initial response to be maintained, whereas a switch might not.…”

Section: Clinical Issues In the Use Of Atypical Antipsychotics In CLImentioning

confidence: 99%

Clinical Issues in Use of Atypical Antipsychotics for Depressed Patients

Pae

Patkar

2013

CNS Drugs

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Major depressive disorder (MDD) is a chronic, recurrent mental disease that causes serious disability. Because currently available antidepressants have limited efficacy with respect to response and remission in patients with MDD, clinicians must choose the best available treatment interventions for patients who do not respond to initial antidepressant treatment. The existing literature demonstrates that augmentation with atypical antipsychotics (AAs) shows higher response and remission rates compared with antidepressant monotherapy, but is associated with more withdrawals due to adverse events. In this paper, specific clinical issues in the use of AA augmentation for patients with MDD are briefly discussed. Given the limited information and clinical knowledge on the proper and effective use of AAs for MDD, future research should focus on practical clinical issues that can be commonly seen in routine practice but have not been addressed yet. This is because the use of AAs is likely to expand as there is good evidence for their effectiveness and tolerability as augmentation therapy for patients with MDD.

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Section: Clinical Issues In the Use Of Atypical Antipsychotics In CLImentioning

confidence: 99%

Clinical Issues in Use of Atypical Antipsychotics for Depressed Patients

Pae

Patkar

2013

CNS Drugs

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“…There is a strong body of evidence for a role of the DA system in depression (for review, see Papakostas et al, 2005;Willner, 1997). Thus, reduced levels of DA and its metabolites (Roy, 1988;Roy et al, 1992), increased DA D2/D3-receptor binding (Klimek et al, 2002) and reduced DA transporter (DAT) binding (Neumeister et al, 2001) were observed in depressed and/or suicidal patients.…”

Section: Introductionmentioning

confidence: 95%

Reciprocal effects of combined administration of serotonin, noradrenaline and dopamine reuptake inhibitors on serotonin and dopamine levels in the rat prefrontal cortex: the role of 5-HT_1A receptors

2007

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The purpose of the present study was to examine, by in vivo microdialysis technique, the effects of triple acting monoamine reuptake inhibitors, constructed by combinations of a selective serotonin reuptake inhibitor citalopram with a noradrenaline/dopamine reuptake inhibitor methylphenidate and a serotonin/noradrenaline reuptake inhibitor venlafaxine with a dopamine reuptake inhibitor GBR12909, on extracellular levels of serotonin (5-HT), noradrenaline (NA) and dopamine (DA) in the prefrontal cortex (PFC) of anaesthetized rats. At the highest dose tested, adjunctive methylphenidate (10 mg/kg s.c.) to citalopram markedly attenuated by 63% the extracellular levels of 5-HT as compared to the levels induced by citalopram (5 mg/kg i.p.) alone, whereas the overall DA concentrations significantly increased to about 149% of those induced by methylphenidate alone. Similarly, the combination of venlafaxine with GBR12909 (10 mg/kg s.c.) caused a reduction of 5-HT levels to 66% of the levels induced by venlafaxine (10 mg/kg i.p.) alone, whereas the overall DA levels increased to 151% of the venlafaxine-treated group. The extracellular levels of NA were only marginally affected by the treatments with combined reuptake inhibitors compared to the effects induced by methylphenidate or venlafaxine alone. The modulatory effects of combined administration of the DA/NA reuptake inhibitors with the 5-HT reuptake inhibitors (citalopram and venlafaxine) on potentiation of DA and attenuation of 5-HT efflux were completely reversed by a pre-treatment with the 5-HT(1A) receptor antagonist WAY-100635. These findings suggest a crucial role played by the 5-HT(1A) receptors in balancing the reuptake inhibitory efficacy for the enhancement of 5-HT and DA transmission in the PFC by the drugs combining the reuptake inhibition of all three monoamines.

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“…However, the existence of residual symptoms or lack of remission after 6-12 weeks of treatment with first-line antidepressants could justify second-line options, such as augmentation or combination therapy [22]. The STAR*D findings suggest that remission rates decrease considerably after two failed trials, supporting the recommendation that two failed trials defines treatment resistance.…”

Section: When Is the Best Time To Start Augmentation Or Combination Tmentioning

confidence: 88%

“…However, the conventional concept for adequate antidepressant treatment is 'wait and see' at least for 6-12 weeks before moving on to the next treatment strategy. Furthermore, there are no definite data or consensus about the most appropriate time for commencing the augmentation agent to current antidepressant yet [22].…”

Section: After 6 Weeks Of Treatment Ms C Was Prescribedmentioning

confidence: 99%

Management of Chronic Depressive Patients with Residual Symptoms

et al. 2013

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Various clinical issues are involved in the appropriate diagnosis and proper treatment interventions for patients with major depressive disorder (MDD). Despite a number of diverse antidepressants for treating MDD now, response and remission rates following adequate trials of antidepressant intervention are still not satisfactory. Furthermore, a significant proportion of MDD patients have residual symptoms, which are associated with increased relapse and recurrence of MDD, leading to negative impacts on the clinical course and outcomes of MDD. Timely and appropriate decision-making regarding the proper management of such cases is required in our routine daily practice. These issues are illustrated and also framed by one MDD case with a complicated clinical course. This review paper may give physicians clinical insight into how we can effectively and properly evaluate and manage such patients in clinical practice.

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A Description of Next-Step Switching Versus Augmentation Practices for Outpatients with Treatment-Resistant Major Depressive Disorder Enrolled in an Academic Specialty Clinic

Cited by 13 publications

References 15 publications

Clinical Issues in Use of Atypical Antipsychotics for Depressed Patients

Clinical Issues in Use of Atypical Antipsychotics for Depressed Patients

Reciprocal effects of combined administration of serotonin, noradrenaline and dopamine reuptake inhibitors on serotonin and dopamine levels in the rat prefrontal cortex: the role of 5-HT_1A receptors

Management of Chronic Depressive Patients with Residual Symptoms

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A Description of Next-Step Switching Versus Augmentation Practices for Outpatients with Treatment-Resistant Major Depressive Disorder Enrolled in an Academic Specialty Clinic

Cited by 13 publications

References 15 publications

Clinical Issues in Use of Atypical Antipsychotics for Depressed Patients

Clinical Issues in Use of Atypical Antipsychotics for Depressed Patients

Reciprocal effects of combined administration of serotonin, noradrenaline and dopamine reuptake inhibitors on serotonin and dopamine levels in the rat prefrontal cortex: the role of 5-HT1A receptors

Management of Chronic Depressive Patients with Residual Symptoms

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Reciprocal effects of combined administration of serotonin, noradrenaline and dopamine reuptake inhibitors on serotonin and dopamine levels in the rat prefrontal cortex: the role of 5-HT_1A receptors