Treatment-resistant depression: New therapies on the horizon

Research output: Contribution to journalArticle

32 Citations (Scopus)

Abstract

Managing patients with treatment-resistant depression (TRD) remains a major challenge for the practicing physician. Depression is considered treatment-resistant when at least two adequate monotherapy trials with drugs from different pharmacologic classes fail to elicit a therapeutic response. Although determining the stage of TRD may allow concise description of a patient's antidepressant history, management of TRD is better served by recent attempts to create a treatment algorithm that encompasses definitive diagnosis of true TRD and strategies for optimizing available therapies, including consideration of novel treatment options. Present strategies for managing TRD include optimization of the initial drug, substitution of another drug from the same or a different antidepressant class, combination of two antidepressants with different mechanisms of action, and adding an antidepressant drug from another class. Potential nonpharmacologic treatments include vagus nerve stimulation, repetitive transcranial magnetic stimulation, and magnetic seizure therapy as an alternative to electroconvulsive therapy. Several neuropeptides and their receptors have also been identified as potential targets for pharmacologic intervention, including corticotropin-releasing factor and substance P. Other treatments currently under investigation include augmentation of antidepressant therapy with an atypical antipsychotic agent such as olanzapine or risperidone. This kind of therapeutic intervention may prove to be especially useful in treating patients with TRD.

Original languageEnglish (US)
Pages (from-to)59-70
Number of pages12
JournalAnnals of Clinical Psychiatry
Volume15
Issue number1
DOIs
StatePublished - Mar 2003

Fingerprint

Treatment-Resistant Depressive Disorder
Antidepressive Agents
Therapeutics
olanzapine
Neuropeptide Receptors
Drug Substitution
Vagus Nerve Stimulation
Electroconvulsive Therapy
Risperidone
Transcranial Magnetic Stimulation
Corticotropin-Releasing Hormone
Substance P
Complementary Therapies
Pharmaceutical Preparations
Antipsychotic Agents
Seizures
History
Depression
Physicians

Keywords

  • Antidepressant nonresponse
  • Depression
  • Drug-resistant major depression
  • Treatment-resistant depression

ASJC Scopus subject areas

  • Psychiatry and Mental health

Cite this

Treatment-resistant depression : New therapies on the horizon. / Trivedi, Madhukar H.

In: Annals of Clinical Psychiatry, Vol. 15, No. 1, 03.2003, p. 59-70.

Research output: Contribution to journalArticle

@article{9bb4b06b8a37404cad048c7882362273,
title = "Treatment-resistant depression: New therapies on the horizon",
abstract = "Managing patients with treatment-resistant depression (TRD) remains a major challenge for the practicing physician. Depression is considered treatment-resistant when at least two adequate monotherapy trials with drugs from different pharmacologic classes fail to elicit a therapeutic response. Although determining the stage of TRD may allow concise description of a patient's antidepressant history, management of TRD is better served by recent attempts to create a treatment algorithm that encompasses definitive diagnosis of true TRD and strategies for optimizing available therapies, including consideration of novel treatment options. Present strategies for managing TRD include optimization of the initial drug, substitution of another drug from the same or a different antidepressant class, combination of two antidepressants with different mechanisms of action, and adding an antidepressant drug from another class. Potential nonpharmacologic treatments include vagus nerve stimulation, repetitive transcranial magnetic stimulation, and magnetic seizure therapy as an alternative to electroconvulsive therapy. Several neuropeptides and their receptors have also been identified as potential targets for pharmacologic intervention, including corticotropin-releasing factor and substance P. Other treatments currently under investigation include augmentation of antidepressant therapy with an atypical antipsychotic agent such as olanzapine or risperidone. This kind of therapeutic intervention may prove to be especially useful in treating patients with TRD.",
keywords = "Antidepressant nonresponse, Depression, Drug-resistant major depression, Treatment-resistant depression",
author = "Trivedi, {Madhukar H.}",
year = "2003",
month = "3",
doi = "10.1023/A:1023232727217",
language = "English (US)",
volume = "15",
pages = "59--70",
journal = "Annals of Clinical Psychiatry",
issn = "1040-1237",
publisher = "Dowden Health Media,Inc",
number = "1",

}

TY - JOUR

T1 - Treatment-resistant depression

T2 - New therapies on the horizon

AU - Trivedi, Madhukar H.

PY - 2003/3

Y1 - 2003/3

N2 - Managing patients with treatment-resistant depression (TRD) remains a major challenge for the practicing physician. Depression is considered treatment-resistant when at least two adequate monotherapy trials with drugs from different pharmacologic classes fail to elicit a therapeutic response. Although determining the stage of TRD may allow concise description of a patient's antidepressant history, management of TRD is better served by recent attempts to create a treatment algorithm that encompasses definitive diagnosis of true TRD and strategies for optimizing available therapies, including consideration of novel treatment options. Present strategies for managing TRD include optimization of the initial drug, substitution of another drug from the same or a different antidepressant class, combination of two antidepressants with different mechanisms of action, and adding an antidepressant drug from another class. Potential nonpharmacologic treatments include vagus nerve stimulation, repetitive transcranial magnetic stimulation, and magnetic seizure therapy as an alternative to electroconvulsive therapy. Several neuropeptides and their receptors have also been identified as potential targets for pharmacologic intervention, including corticotropin-releasing factor and substance P. Other treatments currently under investigation include augmentation of antidepressant therapy with an atypical antipsychotic agent such as olanzapine or risperidone. This kind of therapeutic intervention may prove to be especially useful in treating patients with TRD.

AB - Managing patients with treatment-resistant depression (TRD) remains a major challenge for the practicing physician. Depression is considered treatment-resistant when at least two adequate monotherapy trials with drugs from different pharmacologic classes fail to elicit a therapeutic response. Although determining the stage of TRD may allow concise description of a patient's antidepressant history, management of TRD is better served by recent attempts to create a treatment algorithm that encompasses definitive diagnosis of true TRD and strategies for optimizing available therapies, including consideration of novel treatment options. Present strategies for managing TRD include optimization of the initial drug, substitution of another drug from the same or a different antidepressant class, combination of two antidepressants with different mechanisms of action, and adding an antidepressant drug from another class. Potential nonpharmacologic treatments include vagus nerve stimulation, repetitive transcranial magnetic stimulation, and magnetic seizure therapy as an alternative to electroconvulsive therapy. Several neuropeptides and their receptors have also been identified as potential targets for pharmacologic intervention, including corticotropin-releasing factor and substance P. Other treatments currently under investigation include augmentation of antidepressant therapy with an atypical antipsychotic agent such as olanzapine or risperidone. This kind of therapeutic intervention may prove to be especially useful in treating patients with TRD.

KW - Antidepressant nonresponse

KW - Depression

KW - Drug-resistant major depression

KW - Treatment-resistant depression

UR - http://www.scopus.com/inward/record.url?scp=0038341003&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=0038341003&partnerID=8YFLogxK

U2 - 10.1023/A:1023232727217

DO - 10.1023/A:1023232727217

M3 - Article

C2 - 12839433

AN - SCOPUS:0038341003

VL - 15

SP - 59

EP - 70

JO - Annals of Clinical Psychiatry

JF - Annals of Clinical Psychiatry

SN - 1040-1237

IS - 1

ER -