Tricyclics and newer antidepressant medications: Treatment options for treatment‐resistant depressions

Thase, Michael E.; Rush, A. John; Kasper, S.; Nemeroff, Charles B.

doi:10.1002/depr.3050020307

Cited by 16 publications

(12 citation statements)

References 152 publications

(163 reference statements)

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“…Treatment-resistant depression (TRD) is defined as failure to respond to two adequate medication trials or as a relapse during treatment [7]. The STAR*D trial showed that 60 % of patients with MDD fail to respond to two antidepressant trials of optimal dose and duration, while a further 30 % failed to respond to four medication trials [8].…”

Section: Introductionmentioning

confidence: 99%

A Review of Brain Stimulation Treatments for Late-Life Depression

Blumberger

Hsu

Daskalakis

2015

Curr Treat Options Psych

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Opinion Statement Recurrence, relapse and resistance to first-line therapies are common and pervasive issues in the treatment of depression in older adults. As a result, brain stimulation modalities are essential treatment options in this population. The majority of data for the effectiveness of brain stimulation modalities comes from electroconvulsive therapy (ECT) studies. Current ECT trials are focused on prolonging response after a successful course and mitigating the cognitive adverse effects. Newer forms of brain stimulation have emerged; unfortunately, as with most advances in medicine older adults have not been systematically included in clinical trials. Repetitive transcranial magnetic stimulation has demonstrated efficacy in younger adults and there is emerging data to support its use in late-life depression (LLD). It will be imperative that older adults be included in future transcranial direct current stimulation and magnetic seizure therapy clinical trials. Unclear efficacy results are a concern for both vagus nerve stimulation and deep brain stimulation.

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Section: Introductionmentioning

confidence: 99%

A Review of Brain Stimulation Treatments for Late-Life Depression

Blumberger

Hsu

Daskalakis

2015

Curr Treat Options Psych

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“…"Treatment resistant depression" is a descriptive term that implies failure of the depression to respond to treatment [Baldwin and Simpson, 1997]. However, there is no general consensus regarding criteria for treatment resistance [Guscott and Grof, 1991;Thase et al, 1994Baldwin and Simpson, 1997]. Some authors have suggested that failure to respond to one antidepressant drug given at an adequate dose for a sufficient length of time constitutes treatment resistance, whereas others have used a more stringent definition [Guscott and Grof, 1991;Thase et al, 1994Baldwin and Simpson, 1997].…”

Section: Discussionmentioning

confidence: 99%

“…However, there is no general consensus regarding criteria for treatment resistance [Guscott and Grof, 1991;Thase et al, 1994Baldwin and Simpson, 1997]. Some authors have suggested that failure to respond to one antidepressant drug given at an adequate dose for a sufficient length of time constitutes treatment resistance, whereas others have used a more stringent definition [Guscott and Grof, 1991;Thase et al, 1994Baldwin and Simpson, 1997]. In the absence of consensus criteria for treatment resistance, we adopted a conservative approach (8 weeks of a tricyclic including 2 weeks of adjunctive lithium) so as to increase the chance of including patients who were truly refractory to treatment and decrease the chance of including patients who were simply having a delayed response to treatment.…”

Section: Discussionmentioning

confidence: 99%

Nonresponse to first-line pharmacotherapy may predict relapse and recurrence of remitted geriatric depression

Flint

Rifat

2001

Depress. Anxiety

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The authors examined whether nonresponse to first-line pharmacotherapy was associated with an increased probability of relapse or recurrence following remission of an episode of geriatric depression. The study group consisted of 74 elderly patients whose index episode of nonpsychotic unipolar major depression had responded to antidepressant pharmacotherapy. In 6 of these patients, the depressive episode had not responded to first-line pharmacotherapy (8 weeks of nortriptyline, including 2 weeks of adjunctive lithium) but it had responded to second-line treatment (phenelzine with or without adjunctive lithium). The 74 patients were maintained on acute doses of the medications that had led to response and were followed for 2 years or until relapse or recurrence, whichever occurred first. The cumulative probability of relapse or recurrence was 67% for patients who responded to second-line treatment compared with 18% for patients who responded to first-line treatment (P = 0.0003). As expected, mean time to response was significantly longer for patients who responded to second-line treatment but this factor did not account for the difference in outcome between the two groups. These findings suggest that pharmacotherapy resistance may constitute a risk factor for relapse or recurrence of remitted geriatric depression, even when patients are maintained on the medication that they eventually respond to.

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“…Other studies have reported increased rates of psychiatric comorbidity after interpersonal trauma (Kessler et al, 1995), underdiagnoses in physician practices, underestimates of burden of distress and impairment (Kendler, Gardner, & Prescott, 2002; Mayou & Farmer, 2002), and increased hospitalization for poor treatment response (Firsten, 1991; Thase, Rush, Kasper, & Nemeroff, 1995). Depression associated with histories of CSA often carries with it severe psychological burden, a protracted longitudinal course, and an increased risk of poor treatment response to antidepressant therapy (Boudewyn & Liem, 1995; Hall, Sachs, Rayens, & Lutenbacher, 1993).…”

Section: The Health Effects Of Interpersonal Traumamentioning

confidence: 99%