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Managing inadequate antidepressant response in depressive illness

Lookup NU author(s): Professor Hamish McAllister-Williams

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Abstract

Introduction or background: Depression frequently fails to respond to initial treatment.Sources of data: Predominantly meta-analyses and RCTs but supplemented where necessary by additional data and the authors' clinical experience.Areas of agreement: A systematic assessment to identify remedial causes of poor response should be followed by planned sequential treatment trials. Joint decision making by the patient and clinician is essential. Strategies with the strongest support are antidepressant augmentation with lithium or second generation antipsychotics and adding cognitive behavioural treatment. Electroconvulsive therapy is highly effective in resistant depression but there is a high relapse rate when treatment ends.Areas of controversy: Some pharmacological strategies have inconsistent data (e.g. antidepressant combinations, T3 augmentation) or limited preliminary data (e.g. ketamine, antidepressant augmentation with pramipexole). The efficacy of vagus nerve stimulation, deep brain stimulation and repetitive transcranial magnetic stimulation is unclear.Growing points: A greater understanding of the causes of depression may assist the development of more effective treatments.Areas timely for developing research: Role of glutamate antagonists and psychological treatments, other than cognitive behavioural therapy, as adjunctive treatments.


Publication metadata

Author(s): Haddad PM, Talbot PS, Anderson IM, McAllister-Williams RH

Publication type: Article

Publication status: Published

Journal: British Medical Bulletin

Year: 2015

Volume: 115

Issue: 1

Pages: 183-201

Print publication date: 01/09/2015

Online publication date: 26/08/2015

Acceptance date: 15/07/2015

ISSN (print): 0007-1420

ISSN (electronic): 1471-8391

Publisher: Oxford University Press

URL: http://dx.doi.org/10.1093/bmb/ldv034

DOI: 10.1093/bmb/ldv034


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