Therapeutic Options for Treatment-Resistant Depression

@article{Shelton2010TherapeuticOF,
  title={Therapeutic Options for Treatment-Resistant Depression},
  author={R. Shelton and O. Osuntokun and A. Heinloth and S. Corya},
  journal={CNS Drugs},
  year={2010},
  volume={24},
  pages={131-161}
}
Treatment-resistant depression (TRD) presents major challenges for both patients and clinicians. There is no universally accepted definition of TRD, but results from the US National Institute of Mental Health’s (NIMH) STAR*D (Sequenced Treatment Alternatives to Relieve Depression) programme indicate that after the failure of two treatment trials, the chances of remission decrease significantly.Several pharmacological and nonpharmacological treatments for TRD may be considered when optimized… Expand
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References

SHOWING 1-10 OF 384 REFERENCES
Quetiapine plus SSRI in treatment-resistant depression: possible mechanisms
TLDR
Preliminary and open data indicate that quetiapine may similarly augment SSRIs in TRD, which requires a randomized controlled trial data for confirmation of such effectiveness. Expand
Treatment algorithms in treatment-resistant depression.
TLDR
Following these guidelines should prevent the development of "therapeutic nihilism" in both the patient and physician, as well as enhance the ultimate treatment outcome for patients with treatment-resistant depression. Expand
VNS Therapy in Treatment-Resistant Depression: Clinical Evidence and Putative Neurobiological Mechanisms
TLDR
Evidence from neuroimaging and other studies suggests that VNS therapy acts via innervation of the nucleus tractus solitarius, with secondary projections to limbic and cortical structures that are involved in mood regulation, including brainstem regions that contain serotonergic and noradrenergic regions that project to the forebrain. Expand
Medication Options in the Treatment of Treatment-Resistant Depression
TLDR
When monotherapy provided at the maximum manufacturer-recommended doses for 3–4 weeks has failed to provide remission in depression, the diagnosis should be confirmed, psychotherapy added and psychosocial factors should receive attention. Expand
Issues in treatment-resistant depression.
  • M. Keller
  • Medicine
  • The Journal of clinical psychiatry
  • 2005
Major depressive disorder is a debilitating disease that imposes significant social and economic burdens not only on patients but also on society. Although various treatment options are available,Expand
Sequenced treatment alternatives to relieve depression (STAR*D): rationale and design.
TLDR
The primary outcome is the clinician-rated, 17-item Hamilton Rating Scale for Depression, administered at entry and exit from each treatment level through telephone interviews by assessors masked to treatment assignments. Expand
Adjunctive quetiapine for treatment-resistant adolescent major depressive disorder: a case series.
TLDR
It is suggested that there may be a role for adjunctive quetiapine in treatment-resistant adolescent depression and clinical safety and efficacy trials of quet iapine appear to be warranted. Expand
Diagnosis and definition of treatment-resistant depression
  • M. Fava
  • Medicine, Psychology
  • Biological Psychiatry
  • 2003
TLDR
An accurate and systematic assessment of treatment-resistant depression is a challenge to both clinicians and researchers, with the use of clinician-rated or self-rated instruments being perhaps quite helpful. Expand
Therapeutic Alternatives for Difficult-to-Treat Depression: A Narrative Review of the State of the Evidence
  • M. Thase
  • Psychology, Medicine
  • CNS Spectrums
  • 2004
TLDR
There is a need for greater collaboration among academicians and organizations, such as the American Psychiatric Association, the National Institute of Mental Health, and the pharmaceutical industry, to ensure that sufficient research is conducted so that clinician's choices for patients with TRD can be guided by empirical evidence. Expand
Treatment-resistant depression: definition and treatment approaches.
TLDR
The authors address the problems of defining and treating the estimated 750,000 patients with treatment-resistant depression by suggesting treatment strategies for resistant depression should use systematic algorithms to avoid confusion and limit "therapeutic nihilism" in the patient and physician. Expand
...
1
2
3
4
5
...