treatment-resistant depression
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Introduction
Failure to respond to two antidepressants of adequate duration & dose.
- optimal treatment is 4-6 weeks after the target dose is reached
- the major predictive factor of treatment resistance is a history of unresponsive depression[1]
Management
- treatment-resistant depression likely to respond to cognitive behavioral therapy[2]
- patients with anhedonia, abulia, fatigue, or psychomotor retardation should receive treatment with an SNRI[1]
- ketamine & electroconvulsive therapy effective[3]
- esketamine nasal spray* twice weekly more effective than quetiapine[4]
- remission at 8 weeks more likely with esketamine than quetiapine (27% vs 18%)
- a single dose of psilocybin 25 mg reduces depression scores with 8 days & over a period of 3-6 weeks[5]
More general terms
References
- ↑ 1.0 1.1 1.2 Bennabi D, Charpeaud T, Yrondi A et al Clinical guidelines for the management of treatment-resistant depression: French recommendations from experts, the French Association for Biological Psychiatry and Neuropsychopharmacology and the fondation FondaMental. BMC Psychiatry. 2019 Aug 28;19(1):262. PMID: https://www.ncbi.nlm.nih.gov/pubmed/31455302 PMCID: PMC6712810
- ↑ 2.0 2.1 Geriatrics Review Syllabus, American Geriatrics Society, 5th edition, 2002-2004
Geriatric Review Syllabus, 7th edition Parada JT et al (eds) American Geriatrics Society, 2010
Geriatric Review Syllabus, 8th edition (GRS8) Durso SC and Sullivan GN (eds) American Geriatrics Society, 2013
Geriatric Review Syllabus, 9th edition (GRS9) Medinal-Walpole A, Pacala JT, Porter JF (eds) American Geriatrics Society, 2016
Geriatric Review Syllabus, 11th edition (GRS11) Harper GM, Lyons WL, Potter JF (eds) American Geriatrics Society, 2022 - ↑ 3.0 3.1 Anand A et al. Ketamine versus ECT for nonpsychotic treatment-resistant major depression. N Engl J Med 2023 May 24; [e-pub]. PMID: https://www.ncbi.nlm.nih.gov/pubmed/37224232 https://www.nejm.org/doi/10.1056/NEJMoa2302399
Freedman R. Ketamine and ECT in depression - Risks and rewards. N Engl J Med 2023 May 24; [e-pub] PMID: https://www.ncbi.nlm.nih.gov/pubmed/37224235 https://www.nejm.org/doi/10.1056/NEJMe2305130 - ↑ 4.0 4.1 Reif A et al. Esketamine nasal spray versus quetiapine for treatment-resistant depression. N Engl J Med 2023 Oct 5; 389:1298. PMID: https://www.ncbi.nlm.nih.gov/pubmed/37792613 https://www.nejm.org/doi/10.1056/NEJMoa2304145
- ↑ 5.0 5.1 Goodwin GM, Aaronson ST, Alvarez O et al Single-Dose Psilocybin for a Treatment-Resistant Episode of Major Depression. N Engl J Med 2022; 387:1637-1648. Nov 3. PMID: https://www.ncbi.nlm.nih.gov/pubmed/36322843 https://www.nejm.org/doi/full/10.1056/NEJMoa2206443
Raison CL, Sanacora G, Woolley J et al Single-Dose Psilocybin Treatment for Major Depressive Disorder. A Randomized Clinical Trial. JAMA. Published online August 31, 2023 PMID: https://www.ncbi.nlm.nih.gov/pubmed/37651119 https://jamanetwork.com/journals/jama/fullarticle/2808950