Treatment options for refractory depression
Shelton, R.C.
Journal of Clinical Psychiatry 60(Suppl): 57-61; Discussion 62-63
1999
ISSN/ISBN: 0160-6689 PMID: 10086483 Document Number: 511802
A significant proportion of patients with depressive disorders do not experience a full response with antidepressant treatment. Fortunately, most eventually remit, even though the time to response may be significantly delayed in many patients. A variety of options exist to deal with these difficult clinical situations. Established strategies include switching to an antidepressant of an alternative class (e.g., tricyclic to a monoamine oxidase inhibitor (MAOI) or selective serotonin reuptake inhibitor (SSRI)), electroconvulsive therapy (ECT), and augmentation with lithium or thyroid hormone. Promising alternatives include combined serotonin and norepinephrine enhancement strategies (e.g., SSRI plus serotonin norepinephrine reuptake inhibitor (NSRI) or higher doses of venlafaxine or fluoxetine), steroid suppression therapy, augmentation with atypical antipsychotics, and psychotherapy.