Vol 6 n° 1 - Predictors of Response to Treatment in Neuropsychiatry
Past issues Contributors How to publish Contributions and comments Home
 
epressive disorders are a leading cause of dis- ability worldwide.1,2 By the year 2020, unipolar major depression is projected to be the second leading cause of disability-adjusted life years (DALYS) all over the world.1 Depressive disorders greatly impact morbidity, health care utilization, and medical costs. Despite   advances   in   psychopharmacology   and   the reported high rates of treatment success (usually between 50% and 70%), the general rule of thumb is that less than half of patients beginning a course of antidepressant treat- ment will reach remission with that treatment.3 This implies that a significant proportion of depressed patients either do not respond or continue to have residual symptoms despite treatment with antidepressants. Major depression that does not resolve with adequate antidepressant treat- ment is termed treatment-resistant depression (TRD). P h a r m a c o l o g i c a l   a s p e c t s 5 3 Current perspectives in the management of treatment-resistant depression Rajesh M. Parikh, MD; Barry D. Lebowitz, PhD D Depressive disorders are a leading cause of disability worldwide and greatly impact morbidity, health care utilization, and medical costs. Major depression that does not resolve with adequate antidepressant treatment is termed treat- ment-resistant depression (TRD). There is no universally accepted definition of TRD and several criteria have been sug- gested to define it. Multiple factors can contribute to treatment resistance, including unrecognized comorbid medical or psychiatric illness, the use of concomitant medications, noncompliance, and psychosocial stressors. TRD is associated with extensive use of depression-related and general medical services, and poses a substantial economic burden. Current approaches to its management include the use of antidepressant strategies, such as increasing the dose of the antide- pressant, augmentation strategies, combination strategies, and switching strategies, electroconvulsive therapy, and cog- nitive behavioral therapy. Although no definite algorithm exists for treating TRD, research in this area has advanced considerably in recent years. One approach to this is a clinical trial called STAR*D (Sequenced Treatment Alternatives to Relieve Depression). This has the potential to increase our understanding about the diagnostic and therapeutic aspects of TRD, to substantially reduce disability, and to enhance the quality of life in individuals with this condition. © 2004, LLS SAS Dialogues Clin Neurosci. 2004;6:53-60. Keywords:  treatment-resistant  depression;  management  strategy;  antidepressant treatment Author affiliations: Honarary Consultant Psychiatrist and Neuropsychiatrist, Jaslok Hospital and Research Center, Dr G. Deshmukh Marg, Bombay, India (Rajesh M. Parikh); National Institute of Mental Health, Bethesda, Md, USA (Barry D. Lebowitz) Address  for  correspondence:  Rajesh  M.  Parikh,  MD,  Honarary  Consultant Psychiatrist and Neuropsychiatrist, Jaslok Hospital and Research Center, Dr G. Deshmukh Marg, Bombay 400 026, India (e-mail: rajeshparikh@vsnl.com) This article contains statements about off-label or other non-indicated uses of drugs in psychiatry.  These statements should not be regarded as prescrib- ing information; they simply indicate directions that have been pursued in research. Copyright © 2004 LLS SAS.  All rights reserved www.dialogues-cns.org