Past Issues
Treatment-resistant Depression
David L. Dunner
This overview begins with the issue of definitions of treatment-resistant depres-
sion. From the most common definition of “failure to respond to at least two treat-
ment trials that were delivered at adequate dose and for an adequate duration of
time,” the author has advanced the idea that treatment-resistant depression could be
defined as a first treatment failure to one adequate treatment trial. The outcomes in
patients with complicated treatment-resistant major depression are presented first.
The major portion of this overview is devoted to the descriptions of various strate-
gies from switching antidepressants to augmenting existing antidepressant with an-
other psychotropic drug. Neuromodulating techniques (transcranial magnetic stimu-
lation and Vagus nerve stimulation) as well as the issue of treatment resistant bipolar
depression are also covered at the end of the overview.
Key Word | treatment-resistance, switching of antidepressant, augmentation of antide-pressant therapy, STAR*D |
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