Prevalence and management of treatment-resistant depression.
ABSTRACT Treatment-resistant depression (TRD) is a major public health problem in terms of its prevalence and in terms of individual suffering and cost to society. Best estimates indicate 12-month prevalence rates of approximately 3% for Stage 1 TRD (failure to respond to 1 adequate trial of an antidepressant) and approximately 2% for Stage 2 TRD (failure to respond to 2 adequate trials). The current article provides a brief review of the definitions, prevalence, and various treatment options for TRD, including switching, augmentation, and combination therapies and use of nonpharmacologic treatments. Given the public health importance of TRD, the relative absence of adequately powered, double-blind trials is striking.
Full-textDOI: · Available from: Charles B Nemeroff, Feb 14, 2014
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ABSTRACT: Notwithstanding that major depressive disorder (MDD) is one of the most frequent diagnosed mental illnesses worldwide; it appears to be challenging to successfully treat this psychiatric illness. Although the phenomenon of treatment-resistant depression (TRD) still remains unclear, the subgenual anterior cingulate cortex (sgACC) has been put forward as a possible neurobiological marker to evaluate clinical effects of a variety of antidepressant treatments, including repetitive transcranial magnetic stimulation (rTMS). Accelerated high-frequency (HF)-rTMS may have the potential to rapidly result in beneficial clinical outcomes in TRD. No studies yet examined the clinical effects of such accelerated stimulation treatment paradigms on sgACC regional glucose metabolism (CMRglc), nor the predictive value of the latter for clinical outcome.Brain Stimulation 02/2015; DOI:10.1016/j.brs.2015.01.415 · 5.43 Impact Factor
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ABSTRACT: Major depressive disorder (MDD) is a highly prevalent chronic psychiatric illness associated with significant morbidity, mortality, loss of productivity, and diminished quality of life. Typically, only a minority of patients responds to treatment and meet criteria for remission as residual symptoms may persist, the result of an inadequate course of treatment and/or the presence of persistent side effects. The foremost goal of treatment should be to restore patients to full functioning and eliminate or relieve all MDD symptoms, while being virtually free of troublesome side effects. The current available pharmacological options to manage persistent depressive symptoms include augmentation or adjunctive combination strategies, both of which target selected psychobiological systems and specific mood and somatic symptoms experienced by the patient. As well, non-pharmacological interventions including psychotherapies may be used in either first-line or adjunctive approaches. However, the evidence to date with respect to available adjunct therapies is limited by few studies and those published have utilized only a small number of subjects and lack enough data to allow for a consensus of expert opinion. This underlines the need for further longer term, large population-based studies and those that include comorbid populations, all of which are seen in real world community psychiatry. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.Psychiatry Research 12/2014; 220S1:S15-S33. DOI:10.1016/S0165-1781(14)70003-4 · 2.68 Impact Factor
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ABSTRACT: Depression is one of the major global health challenges and a leading contributor of health related disability and costs. Depression is a heterogeneous disorder and current methods for assessing its severity in clinical practice rely on symptom count, however this approach is unreliable and inconsistent. The clinical evaluation of depressive symptoms is particularly challenging in primary care, where the majority of patients with depression are managed, due to the presence of co-morbidities. Current methods for risk assessment of depression do not accurately predict treatment response or clinical outcomes. Several biological pathways have been implicated in the pathophysiology of depression; however, accurate and predictive biomarkers remain elusive. We conducted a systematic review of the published evidence supporting the use of peripheral biomarkers to predict outcomes in depression, using Medline and Embase. Peripheral biomarkers in depression were found to be statistically significant predictors of mental health outcomes such as treatment response, poor outcome and symptom remission; and physical health outcomes such as increased incidence of cardiovascular events and deaths, and all-cause mortality. However, the available evidence has multiple methodological limitations which must be overcome to make any real clinical progress. Despite extensive research on the relationship of depression with peripheral biomarkers, its translational application in practice remains uncertain. In future, peripheral biomarkers identified with novel techniques and combining multiple biomarkers may have a potential role in depression risk assessment but further research is needed in this area.Frontiers in Human Neuroscience 02/2015; 9:18. DOI:10.3389/fnhum.2015.00018 · 2.90 Impact Factor