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Pharmacological management of treatment resistant depression: a clinical review

Published online by Cambridge University Press:  13 June 2014

Noel Kennedy  and
Michael McDonough
Noel Kennedy
Affiliation:
Box 63, Institute of Psychiatry, London, England
Michael McDonough
Affiliation:
Maudsley Hospital, London, England
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Abstract

Objectives: Treatment resistant depression (TRD), commonly encountered in clinical practice, leads to socioeconomic disability and therapeutic pessimism. This paper reviews evidence for pharmacological approaches used in TRD.

Method: Electronic literature searches were performed using Medline and Psychlit using broad search terms relating to TRD.

Results: Agents that potentiate both serotonin and noradrenaline may allow more patients to achieve full remission. Attention must be paid to dose titration and length of treatment courses in TRD. Augmentation with lithium and switching within antidepressant class or between classes can often improve symptoms but efficacy of other augmentation approaches remains uncertain. Antidepressant combinations and addition of atypical antipsychotics can be useful but combinations of predominantly serotonergic antidepressants should be avoided. Electroconvulsive therapy retains an important role in TRD but pharmacological treatments need to be continued concomitantly.

Conclusions: Good improvement is seen in TRD after vigorous antidepressant treatment but most patients continue to have lower grade symptomatology.

Keywords

Treatment resistant depressionAntidepressant augmentationAntidepressant switchingCombination antidepressantsElectroconvulsive therapyNeurosurgery
Type
Review
Information
Irish Journal of Psychological Medicine , Volume 20 , Issue 1 , March 2003 , pp. 18 - 23
Copyright
Copyright © Cambridge University Press 2000

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