Critical review of available treatment options for treatment refractory depression and anxiety - clinical and ethical dilemmas

Abstract

Treatment-resistant mood and anxiety disorders require an intensive therapeutic approach, and it should balance benefits and adverse effects or other potential detrimental effects of medications. The goal of treatment is to provide consistent and lasting improvement in symptoms of depression and anxiety. Beozodiazepines are effective for anxiety symptoms, but with no sustained treatment effects. Other medication treatment options for anxiety disorders are outlined. Ketamine is usually very effective in treating maior depressive disorder but without sustained benefits. Loog-term use may pose a signiticant risk of developing tolerance and dependence. Stimulant medication augmentation for treatment-resistant depression is effective for residual symptoms of depression, but effects are usually short-lasting and it sounds mor as an artificial way of improving energy, alertness and cognitive functioning. Synthetic cannabinoids and medical marijuana are increasingly prescribed for various medical conditions. but more recently also for patients with mood and anxiety disorders. All of these treatments may raise ethical dilemmas about appropriateness of prescribing these medications and a number of questions regarding the optimal treatment for patients with treatment-resistant depression and treatment refractory anxiety disorders.

Synergistic antidepressant- and anxiolytic-like effects of harmaline along with cinanserin in acute restraint stress-treated mice

“…Depressive and anxiety disorders are the most common psychiatric conditions in clinical studies. These disorders need a broad therapeutic approach so that it should balance benefits and adverse properties or other potentially detrimental properties of medications (Kolar and Kolar 2016;Tiller 2013). Anxiety-like behaviors, along with depressive-like actions, can be produced using various paradigms such as acute and constant stress exposure, prolonged stress, chronic social defeat, and pre/post-natal stress (Bailey and Crawley 2009).…”

The associations of CNR1 SNPs and haplotypes with vulnerability and treatment response phenotypes in Han Chinese with major depressive disorder: A case–control association study

“…Endocannabinoids have the ability to regulate different physiological processes involving in mood disorders, particularly including the activity of hypothalamic–pituitary–adrenal (HPA) axis and neuro‐inflammatory cytokines release (Cota et al, 2007 ; Yu et al, 2010 ), which both are deranged in MDD (Dantzer et al, 2011 ; Pace et al, 2007 ). In line with the role of dysregulated inflammation in the development of depression and antidepressant treatment resistance (Carvalho et al, 2013 ), endocannabinoid system also is relevant to the pathophysiology and treatment resistance for MDD (Garcia‐Gutierrez et al, 2010 ; Kolar & Kolar, 2016 ). Cannabinoid type 1 (CB1) receptor is a primary mediator of endocannabinoids in the central nervous system, and is highly expressed in the amygdala, hypothalamus, prefrontal cortex, hippocampus, and basal ganglia (Mackie, 2005 ).…”

Next-Generation Personalized Medicine: Implementation of Variability Patterns for Overcoming Drug Resistance in Chronic Diseases

“…A substantial proportion of subjects with depression ultimately develop treatment-resistant or refractory depression (TRD) [ 57 , 58 ]. The current therapy for TRD involves evaluating comorbid medical and psychiatric conditions and attempts to enhance antidepressant efficacy by augmentation, combination, or switching of anti-depressants [ 57 , 59 ]. However, a majority of TRD patients do not adequately respond.…”