期刊
ANNALS OF MEDICINE
卷 43, 期 7, 页码 512-530出版社
TAYLOR & FRANCIS LTD
DOI: 10.3109/07853890.2011.583675
关键词
Depression; resistance; treatment
资金
- Spanish Ministry of Health, Instituto de Salud Carlos III, CIBER-SAM
- Spanish Ministry of Science and Innovation, Instituto Carlos III, through a 'Miguel Servet' [CP08/00140]
- FIS [PS09/01044]
- Almirall
- AstraZeneca
- Bristol-Myers Squibb
- Eli Lilly
- Forest Research Institute
- Geodon Richter
- GlaxoSmithKline
- Janssen-Cilag
- Jazz
- Lundbeck
- Merck
- Novartis
- Organon
- Otsuka
- Pfizer Inc.
- Sanofi aventis
- Servier
- Solvay
- Schering-Plough
- Takeda
- United Biosource Corporation
- Wyeth
- Spanish Ministry of Science and Innovation
- Stanley Medical Research Institute
- European Union
- Spanish Ministry of Science and Innovation, Instituto de Salud Carlos III
The phenomenon of treatment-resistant depression (TRD), described as the occurrence of an inadequate response after an adequate treatment with antidepressant agents (in terms of dose, duration, and adherence), is very common in clinical practice. It has been broadly defined in the context of unipolar major depression, but alternative definitions for bipolar depression have also been suggested. In both cases, there is a remarkable lack of consensus amongst professionals concerning its operative definition. A relatively wide variety of treatment options for unipolar TRD are available, whilst the evidence is very scanty for bipolar TRD. TRD is associated to poor clinical, functional, and social outcomes. Several novel therapeutic options are currently being investigated as promising alternatives, targeting the neurotransmitter system outside of the standard monoamine hypothesis. Augmentation or combination with lithium or atypical antipsychotics appears as a valid option for both conditions, and the same occurs with electroconvulsive therapy. Other non-pharmacological strategies such as deep brain stimulation may be promising alternatives for the future. The use of cognitive behaviour therapy is recommended for unipolar TRD, but there is no evidence supporting its use in bipolar TRD.
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