Therapy-resistant depression

Abstract

Therapy-resistant depression is not untreatable. Numerous treatment methods with substantiated effectiveness exist. However, none of them are able to ensure remission. Thus, what matters when treating therapy-resistant depression is the strict, step-by-step deployment of existing therapeutic options at the right tempo and with a regular systematic evaluation of patient response. Remission should always be the aim, not just some abatement in symptoms (response). The following should be avoided: too small dosages of medication; changing the therapeutic strategy too frequently or too quickly; thoughtlessly sticking to an ineffective treatment over too long a period of time; or unsystematic poly-pharmacy. If these are all avoided than therapy-resistant depressive patients will have a good chance of recovery.

Keywords::

• antidepressants
• combining antidepressants
• electroconvulsive therapy
• high dose
• lithium augmentation
• switching the antidepressant
• therapeutic algorithm
• therapy-resistant depression

Financial & competing interests disclosure

The author has received lecturing fees from the companies Lilly, Esparma, Sanofi Aventis, Boehringer-Ingelheim and GSK and has also received contributions towards conference travel expenses from Lilly and Servier. The author has no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

No writing assistance was utilized in the production of this manuscript.

Notes

See Table 2 for an example of the antidepressive stepwise treatement algorithm.

Reproduced from [44].