Treatment-Resistant Depression: New Therapies on the Horizon

Annals of Clinical Psychiatry - 2003
Madhukar H. Trivedi1
1Depression and Anxiety Disorders Program, The University of Texas, Southwestern Medical School, Dallas

Tóm tắt

Managing patients with treatment-resistant depression (TRD) remains a major challenge for the practicing physician. Depression is considered treatment-resistant when at least two adequate monotherapy trials with drugs from different pharmacologic classes fail to elicit a therapeutic response. Although determining the stage of TRD may allow concise description of a patient's antidepressant history, management of TRD is better served by recent attempts to create a treatment algorithm that encompasses definitive diagnosis of true TRD and strategies for optimizing available therapies, including consideration of novel treatment options. Present strategies for managing TRD include optimization of the initial drug, substitution of another drug from the same or a different antidepressant class, combination of two antidepressants with different mechanisms of action, and adding an antidepressant drug from another class. Potential nonpharmacologic treatments include vagus nerve stimulation, repetitive transcranial magnetic stimulation, and magnetic seizure therapy as an alternative to electroconvulsive therapy. Several neuropeptides and their receptors have also been identified as potential targets for pharmacologic intervention, including corticotropin-releasing factor and substance P. Other treatments currently under investigation include augmentation of antidepressant therapy with an atypical antipsychotic agent such as olanzapine or risperidone. This kind of therapeutic intervention may prove to be especially useful in treating patients with TRD.

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Wells KB, Stewart A, Hays RD, Burnam MA, Rogers W, Daniels M, Berry S, Greenfield S, Ware J: The functioning and well-being of depressed patients: Results from the Medical Outcomes Study. JAMA 1989; 262:914-919

Hirschfeld RM, Russell JM: Assessment and treatment of suicidal patients. N Engl J Med 1997; 337:910-915

Agency for Health Care Policy and Research. Depression in primary care: Guideline overview. J Natl Med Assoc 1993; 85(7):501-503

Nierenberg AA, White K: What next? A review of pharmacologic strategies for treatment resistant depression. Psychopharm Bull 1990; 26:429-460

Thase ME, Kupfer DJ: Characteristics of treatment-resistant depression. In: Zohar J, Belmaker RH, eds. Treating Resistant Depression: II. New York: PMA Publishing; 1987: 23-45

Fava M, Davidson KG: Definition and epidemiology of treatment-resistant depression. Psychiatr Clin North Am 1996; 19:179-200

Thase ME, Rush AJ: When at first you don't succeed: Sequential strategies for antidepressant responders. J Clin Psychiatry 1997; 58(Suppl. 13):23-29

Rush AJ, Trivedi MH: Treating depression to remission. Psychiatr Ann 1995; 25:704-709

Thase ME, Rush AJ: Treatment-resistant depression. In: Bloom FE, Kupfer DJ, eds. Psychopharmacology: The Fourth Generation of Progress. New York: Raven Press; 1995:1081-1097

Thase ME, Howland RH, Friedman ES: Treating antidepressant nonresponders with augmentation strategies: An overview. J Clin Psychiatry 1998; 59(Suppl. 5):5-12

Trivedi MH, Kleiber BA: Using treatment algorithms for the effective management of treatment-resistant depression. J Clin Psychiatry 2001; 62(Suppl)18:25-29.

Trivedi MH, Rush AJ, Pan JY, Carmody TJ: Which depressed patients respond to nefazodone and when? J Clin Psychiatry 2001; 62(3):158-163

Enns MW, Swenson JR, McIntyre RS, Swinson RP, Kennedy SH: CANMAT Depression Work Group. Clinical guidelines for the treatment of depressive disorders VII: comorbidity. Can J Psychiatry 2001; 46(Suppl. 1):77S-90S

Franco-Bronson K: The management of treatment-resistant depression in the medically ill. Psychiatr Clin North Am 1996; 19(2):329-350

Cadieux RJ: Practical management of treatment-resistant depression. Am Fam Physician 1998; 58:2059-2062

Keller MB, Lavori PW, Mueller TI, Endicott J, Coryell W, Hirschfeld RM, Shea T: Time to recovery, chronicity and levels of psychopathology in major depression: A five-year prospective follow-up of 431 subjects. Major depressive disorder. Arch Gen Psychiatry 1992; 49:809-816

Frank E, Kupfer DJ, Perel JM, Cornes C, Jarrett DB, Mallinger AG, Thase ME, McEachran AB, Grochocinski VJ: Three-year outcomes for maintenance therapies in recurrent depression. Arch Gen Psychiatry 1990; 47:1093-1099

Byrne SE, Rothschild AJ: Loss of antidepressant efficacy during maintenance therapy: Possible mechanisms and treatment. J Clin Psychiatry 1998; 59:279-288

Zajecka JM: Clinical issues in long-term treatment with antidepressants. J Clin Psychiatry 2000; 61(Suppl. 2):20-25

Nelson JC: Overcoming treatment resistance in depression. J Clin Psychiatry 1998; 59(Suppl. 16):13-19

Fava M: Management of nonresponse and intolerance: Switching strategies. J Clin Psychiatry 2000; 61(Suppl. 2):10-12

Brown W, Harrison W: Are patients who are intolerant to one SSRI intolerant to another? Psychopharmacol Bull 1992; 28:253-256

Brown WA, Harrison W: Are patients who are intolerant to one serotonin selective reuptake inhibitor intolerant to another? J Clin Psychiatry 1995; 56(1):30-34

Joffe RT, Levitt AJ, Sokolov ST, Young LT: Response to an open trial of a second SSRI in major depression. J Clin Psychiatry 1996; 57:114-115

Thase ME, Blomgren SL, Birkett MA, Apter JT, Tepner RG: Fluoxetine treatment of patients with major depressive disorder who failed initial treatment with sertraline. J Clin Psychiatry 1997; 58(1):16-21

Nurnberg HG, Thompson PM, Hensley PL: Antidepressant medication change in a clinical treatment setting: A comparison of the effectiveness of selective serotonin reuptake inhibitors. J Clin Psychiatry 1999; 60(9):574-579

Fredman SJ, Fava M, Kienke AS: Partial response, non-response, and relapse with selective serotonin reuptake inhibitors in major depression: A survey of current “next-step” practices. J Clin Psychiatry 2000; 61:403-408

Thase ME, Rush AJ, Howland RH, Kornstein SG, Kocsis JH, Gelenberg AJ, Schatzberg AF, Koran LM, Keller MB, Russell JM, Hirschfeld RM, LaVange LM, Klein DN, Fawcett J, Harrison W: Double-blind switch study of imipramine or sertraline treatment of antidepressant-resistant chronic depression. Arch Gen Psychiatry 2002; 59(3):233-239

Thase ME, Friedman ES, Howland RH: Venlafaxine and treatment-resistant depression. Depress Anxiety 2000; 12(Suppl. 1):55-62

Fava M, Dunner DL, Greist JH, Preskorn SH, Trivedi MH, Zajecka J, Cohen M: Efficacy and safety of mirtazapine in major depressive disorder patients after SSRI treatment failure: An open-label trial. J Clin Psychiatry 2001; 62(6):413-420

Nelson JC: Augmentation strategies in depression 2000. J Clin Psychiatry 2000; 61(Suppl. 2):13-19

Rush AJ, Prien RF: From scientific knowledge to the clinical practice of psychopharmacology: can the gap be bridged? Psychopharmacol Bull 1995; 31(1):7-20

Zajecka J, Tracy KA, Mitchell S: Discontinuation symptoms after treatment with serotonin reuptake inhibitors: A literature review. J Clin Psychiatry 1997; 58(7):291-297

Rothschild AJ, Samson JA, Bessette MP, Carter-Campbell JT: Efficacy of the combination of fluoxetine and perphenazine in the treatment of psychotic depression. J Clin Psychiatry 1993; 54:338-342

Wolfersdorf M, Konig F, Straub R: Pharmacotherapy of delusional depression: Experience with combination of antidepressants with zotepine and haloperidol as neuroleptics. Neuropsychobiology 1994; 29:189-193

Tran PV, Dellva MA, Tollefson GD, Beasley CM, Jr, Potvin JH, Kiesler GM: Extrapyramidal symptoms and tolerability of olanzapine versus haloperidol in the acute treatment of schizophrenia. J Clin Psychiatry 1997; 58:205-211

Tollefson GD, Beasley CM, Jr, Tamura RN, Tran PV, Potvin JH: Blind, controlled, long-term study of the comparative incidence of treatment-emergent tardive dyskinesia with olanzapine or haldol. Am J Psychiatry 1997; 154:1248-1254

Borison RL, Pathiraja AP, Diamond BI, Meibach RC: Risperidone: Clinical safety and efficacy in schizophrenia. Psychopharmacol Bull 1992; 28:213-218

Lukoski JM, Aghajanian GK: Effects of ketanserin on neuronal responses to serotonin in the prefrontal cortex, lateral geniculate, and dorsal raphe nucleus. Neuropharmacology 1985; 24:265-273

Ostroff R, Nelson JC: Risperidone augmentation of SSRIs in major depression. J Clin Psychiatry 1999; 50:256-259

Zhang W, Bymaster FP: The in vivo effects of olanzapine and other antipsychotic agents on receptor occupancy and antagonism of dopamine D1, D2, D3, 5HT2A and muscarinic receptors. Psychopharmacology 1999; 141:267-278

Bymaster FP, Calligaro DO, Falcone JF, Marsh RD, Moore NA, Tye NC, Seeman P, Wong DT: Radioreceptor binding profile of the atypical antipsychotic olanzapine. Neuropsychopharmacology 1996; 14:87-96

Tollefson GD, Sanger TM, Lu Y, Thieme ME: Depressive signs and symptoms in schizophrenia: A prospective blinded trial of olanzapine and haloperidol. Arch Gen Psychiatry 1998; 55:250-258

Shelton RC, Tollefson GD, Tohen M, Stahl S, Gannon KS, Jacobs TG, Buras WR, Bymaster FP, Zhang W, Spencer KA, Feldman PD, Meltzer HY: A novel augmentation strategy for treating resistant major depression. Am J Psychiatry 2001; 58:131-134

Zhang W, Perry KW, Wong DT, Potts BD, Bao J, Tollefson GD, Bymaster FP: Synergistic effects of olanzapine and other antipsychotic agents in combination with fluoxetine on norepinephrine and dopamine release in rat prefrontal cortex. Neuropsychopharmacology 2000; 23:250-262

Harro J, Oreland L: Depression as a spreading adjustment disorder of monoaminergic neurons: A case for primary implication of the locus coeruleus. Brain Res Brain Res Rev 2001; 38(1/2):79-128

Pacher P, Kohegyi E, Kecskemeti V, Furst S: Current trends in the development of new antidepressants. Curr Med Chem 2001; 8(2):89-100

Lesch K P: Mouse anxiety: The power of knockout. Pharmacogenomics J 2001; 1(3):187-192

Steinberg R, Alonso R, Griebel G, Bert L, Jung M, Oury-Donat F, Poncelet M, Gueudet C, Desvignes C, Le Fur G, Soubrie P: Selective blockade of neurokinin-2 receptors produces antidepressant-like effects associated with reduced corticotropin-releasing factor function. J Pharmacol Exp Ther 2001; 299(2):449-458

Haddjeri N, Blier P: Sustained blockade of neurokinin-1 receptors enhances serotonin neurotransmission. Biol Psychiatry 2001; 50(3):191-199

Handforth A, DeGiorgio CM, Schachter SC, Uthman BM, Naritoku DK, Tecoma ES, Henry TR, Collins SD, Vaughn BV, Gilmartin RC, Labar DR, Morris GL 3rd, Salinsky MC, Osorio I, Ristanovic RK, Labiner DM, Jones JC, Murphy JV, Ney GC, Wheless JW: Vagus nerve stimulation therapy for partial-onset seizures. Neurology 1998; 51:48-55

The Vagus Nerve Study Group. A randomized controlled trial of chronic vagus nerve stimulation for treatment of medically intractable seizures. Neurology 1995; 45:224-30

George MS, Sackeim HA, Rush AJ, Marangell LB, Nahas Z, Husain MM, Lisanby S, Burt T, Goldman J, Ballenger JC: Vagus nerve stimulation: A new tool for brain research and therapy. Biol Psychiatry 2000; 47:287-295

Rush AJ, George MS, Sackeim HA: Vagus nerve stimulation (VNS) for treatment-resistant depressions: A multicenter study. Biol Psychiatry 2000; 47:276-286

Rosenbaum JF, Heninger G: Vagus nerve stimulation for treatment-resistant depression. Biol Psychiatry 2000; 47:273-275. Editorial.

Wassermann EM, Lisanby SH: Therapeutic application of repetitive transcranial magnetic stimulation: A review. Clin Neurophysiology 2001; 112:1367-1377

Padberg F, Zwanzger P, Thoma H, Kathmann N, Haag C, Greenberg BD, Hampel H, Moller HJ: Repetitive transcranial magnetic stimulation (rTMS) in pharmacotherapy-refractory major depression: Comparative study of fast, slow, and sham rTMS. Psychiatr Res 1999; 88:163-171

Loo C, Mitchell P, Sachdev P, McDarmont B, Parker G, Gandevia S: Double-blind controlled investigation of transcranial magnetic stimulation for the treatment of resistant major depression. Am J Psychiatry 1999; 156:946-948

Berman RM, Narasimhan M, Sanacora G, Miano AP, Hoffman RE, Hu XS, Charney DS, Boutros NN: A randomized clinical trial of repetitive transcranial magnetic stimulation in the treatment of major depression. Biol Psychiatry 2000; 47:332-337

Lisanby SH, Luber B, Finck AD, Schroeder C, Sackeim HA: Deliberate seizure induction with repetitive transcranial magnetic stimulation. Arch Gen Psychiatry 2001; 58:199-200 Erratum in: Arch Gen Psychiatry 2001; 58:515

Lisanby SH, Schlaepfer TE, Fisch HU, Sackeim HA: Magnetic seizure induction for the treatment of major depression [letter]. Arch Gen Psychiatry 2001; 58:303-305

Lisanby SH, Luber B, Barroilhet L, Neufeld E, Schlaepfer T, Sackeim HA: Magnetic seizure therapy (MST): Acute cognitive effects of MST compared with ECT. J ECT 2001; 17:77. Abstract 4

Crismon ML, Trivedi M, Pigott TA, Rush AJ, Hirschfeld RM, Kahn DA, DeBattista C, Nelson JC, Nierenberg AA, Sackeim HA, Thase ME: The Texas Medication Algorithm Project: Report of the Texas Consensus Conference Panel on medication treatment of major depressive disorder. J Clin Psychiatry 1999; 60:142-156

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Annals of Clinical Psychiatry

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