Treatment-resistant depression

From LIMSWiki
Jump to navigationJump to search

Treatment-resistant depression
Other namesTreatment-refractory depression
SpecialtyPsychiatry
SymptomsDepressive mood, anhedonia, low energy
ComplicationsSelf-harm, suicide

Treatment-resistant depression (TRD) is often defined as major depressive disorder in which an affected person does not respond adequately to at least two different antidepressant medications at an adequate dose and for an adequate duration.[1] Inadequate response has most commonly been defined as less than 25% reduction in depressive symptoms following treatment with an antidepressant.[2] Many clinicians and researchers question the construct validity and clinical utility of treatment-resistant depression as currently conceptualized.[3][4] There is ongoing debate as to whether inadequate response to other treatment modalities, such as psychotherapy, should be included in defining TRD.[5]

Treatment resistance is becoming more prominent with nearly 30% of individuals with major depressive disorder being termed treatment-resistant as defined above.[6] There are many factors that may contribute to inadequate treatment, such as: a history of repeated or severe adverse childhood experiences, early discontinuation of treatment, failure to consider psychotherapy and other psychosocial interventions, patient noncompliance, misdiagnosis, cognitive impairment, low income and other social determinants, and concurrent medical conditions, including comorbid psychiatric disorders.[2] Cases of treatment-resistant depression may also be referred to by which medications people are resistant to (e.g.: SSRI-resistant).[7] They may also be staged based on how many treatments they have tried.[8] Despite being called treatment-resistant, there are many treatment options available which are described in the treatment section below.

Risk factors

Comorbid psychiatric disorders

Comorbid psychiatric disorders commonly go undetected in the treatment of depression. If left untreated, the symptoms of these disorders can interfere with both evaluation and treatment. Anxiety disorders are one of the most common disorder types associated with treatment-resistant depression. The two disorders commonly co-exist, and have some similar symptoms. Some studies have shown that patients with both major depressive disorder and panic disorder are the most likely to be nonresponsive to treatment. Substance abuse may also be a predictor of treatment-resistant depression. It may cause depressed patients to be noncompliant in their treatment, and the effects of certain substances can worsen the effects of depression. Other psychiatric disorders that may predict treatment-resistant depression include attention deficit hyperactivity disorder,[9] personality disorders, obsessive compulsive disorder, and eating disorders.[10]

Comorbid medical disorders

Some people who are diagnosed with treatment-resistant depression may have an underlying undiagnosed health condition that is causing or contributing to their depression. Endocrine disorders like hypothyroidism, Cushing's disease, and Addison's disease are among the most commonly identified as contributing to depression. Others include diabetes, coronary artery disease, cancer, HIV, and Parkinson's disease. Another factor is that medications used to treat comorbid medical disorders may lessen the effectiveness of antidepressants or cause depression symptoms.[10]

Features of depression

People with depression who also display psychotic symptoms such as delusions or hallucinations are more likely to be treatment resistant. Another depressive feature that has been associated with poor response to treatment is longer duration of depressive episodes.[7] Individuals with depression who struggle with insomnia or develop depression at a younger age are also more likely to resistant to treatment.[11] Finally, people with more severe depression and those who are suicidal are more likely to be nonresponsive to antidepressant treatment.[12]

Demographic

Multiple populations have been identified as being more at risk for treatment resistance. Individuals who are not married or identify as single are one of these groups that may be more at risk.[11] Another population who seems to have poor response to treatment are individuals who are unemployed.[13] Finally, while both male and female gender have been identified as risk factors, it appears that females are more prone to struggle with resistance to treatment.[14]

Treatment

See also: Management of depression

There are multiple strategies that can be used when a medication course is found to be ineffective. The first would be to increase the dosage of medication. Another option is to switch the patient to a different medication. The last two strategies, combination therapy and augmentation therapy, include adding a medication to the patient's current treatment. Combination therapy involves the addition of a different type of antidepressant while augmentation therapy requires adding a non-antidepressant medication such as a mood stabilizer.[15] These treatment options are discussed in more detail below.

Medication

Antidepressants

Dose increase

Increasing the dosage of an antidepressant is a common strategy to treat depression that does not respond after adequate treatment duration. Practitioners who use this strategy will usually increase the dose until the person reports intolerable side effects, symptoms are eliminated, or the dose is increased to the limit of what is considered safe.[16]

Switching or combining antidepressants

Studies have shown a wide variability in the effectiveness of switching antidepressants, with anywhere from 25 to 70% of people responding to a different antidepressant.[17] There is support for the effectiveness of switching people to a different SSRI; 50% of people that were non-responsive after taking one SSRI were responsive after taking a second type. Switching people with treatment-resistant depression to a different class of antidepressants may also be effective. People who are non-responsive after taking an SSRI may respond to moclobemide or tricyclic antidepressants, bupropion or an MAOI.[16]

Ketamine has been tested as a rapid-acting antidepressant[18] for treatment-resistant depression in bipolar disorder, and major depressive disorder.[19] Spravato, a nasal spray form of esketamine, was approved by the FDA in 2019 for use in treatment-resistant depression when combined with an oral antidepressant.[20][21] One promising finding regarding ketamine has been a reduced suicide rate in patients struggling with treatment resistance.[22] While ketamine does appear to have some effectiveness in treating treatment-resistant depression, there seems to be significant variability in its effect.[23]

Some low to moderate quality evidence points to success in the short term (8–12 weeks) using mianserin to augment antidepressant medications. Simply switching to mianserin might also produce an improvement, but the effect size is smaller. No data on quality of life is reported. Data derived from a single study meeting Cochrane 2019 inclusion criteria.[24] The antidepressant mirtazapine has also been used for augmentation. One study on this practice was included in the Cochrane 2019 meta-analysis. The study found that mirtazapine augmentation is not superior to placebo augmentation.[24]

Stimulants, or dopaminergic and/or norepinephrinergic agents

Stimulants are a class of medications that are most commonly used to treat inattention disorders such as ADHD, but they have also been used to treat patients with depression struggling with treatment resistance.[25] Some of the stimulants that have been studied in treatment-resistant depression include methylphenidate, lisdexamfetamine, modafanil, and atomoxetine.[26] When used, these medications are commonly used to augment traditional antidepressants and while there seems to be a wide range of effects, they do appear to have some benefit, especially in patients struggling with low energy, poor motivation and inattention as a result of their depression.[27]

While these medications can be useful, there are some general contraindications to be mindful of. First, these medications are usually avoided in patients with a history of substance abuse due to their abuse potential. However, both modafinil and atomoxetine can be considered in this population due to their lower abuse potential.[28] In addition, stimulants are generally avoided in patients with heart problems and severe hypertension.[29] Other important considerations include history of psychosis as well as anxiety, as both of these may be worsened while taking stimulants.[30]

Other medications

Medications that have been shown to be effective in people with treatment-resistant depression include lithium, liothyronine, benzodiazepines, atypical antipsychotics, and stimulants. Adding lithium may be effective for people taking some types of antidepressants including SSRIs or SNRIs. Lithium augmentation therapy was associated with a 41.2% remission rate of unipolar depression compared to 14.4% with placebo.[31][32] Liothyronine (synthetic T3) is a type of thyroid hormone and has been associated with improvement in mood and depression symptoms. Benzodiazepines may improve treatment-resistant depression by decreasing the adverse side effects caused by some antidepressants and therefore increasing patient compliance.[33]

Atypical antipsychotics such as aripiprazole, quetiapine or olanzapine can be added to anti-depressants as part of augmentation of treatment.[32] Eli Lilly, the company that sells both olanzapine and fluoxetine individually, has also released a combination formulation which contains olanzapine and fluoxetine in a single capsule. Some low to moderate quality evidence (7 studies meeting Cochrane 2019 inclusion criteria) point to success in the short term (8–12 weeks) using antipsychotics cariprazine, olanzapine, quetiapine or ziprasidone to augment antidepressant medications.[24] These have shown promise in treating refractory depression but come with more serious side effects.[34] Among studies studies meeting the Cochrane 2019 inclusion criteria, two report that quetiapine augmentation does not improve overall quality of life.[24]

One study on the 5-HT1A receptor partial agonist buspirone met the Cochrane 2019 inclusion criteria. It reported that buspirone augmentation did not provide an improvement over placebo augmentation.[24] Ultimately, there are many medications that have been tried in treatment-resistant depression with varying effects.

Research

A 2016 placebo randomized controlled trial evaluated the rapid antidepressant effects of the psychedelic ayahuasca in treatment-resistant depression with positive outcome.[35][36]

In 2018, the United States Food and Drug Administration (FDA) granted breakthrough therapy designation for psilocybin-assisted therapy for treatment-resistant depression.[37][38] A systematic review published in 2021 found that the use of psilocybin as a pharmaceutical substance was associated with reduced intensity of depression symptoms.[39]

Physical psychiatric treatments

Electroconvulsive therapy

Electroconvulsive therapy (ECT) is generally only considered as a treatment option in severe cases of treatment-resistant depression. It is used when medication has repeatedly failed to improve symptoms, and usually when the patient's symptoms are so severe that they have been hospitalized. It involves inducing a controlled seizure in a patient for a short time (30-90 seconds). Often patients receive a total of 6-12 sessions over the course of multiple weeks (receiving 2-3 sessions per week).

Electroconvulsive therapy has been found to reduce thoughts of suicide and relieve depressive symptoms.[40] It has also been used to treat patients suffering from mania, psychosis, catatonia, and more. While the exact mechanism by which ECT treats depression is unknown, we know that many aspects of the brains chemical structure and function are altered during seizure activity.[41] This includes alterations of important neurotransmitters such as serotonin, norepinephrine, and dopamine.[42] It is also associated with an increase in glial cell line derived neurotrophic factor.[43]

When considering ECT, it is important to take into account the potential side effects. Most commonly, patients report cognitive impairments including difficulty with short-term and autobiographical memory as well as attention and learning.[41] While these side effects can be distressing, they are often short-term and resolve within a few days with many patients seeing an overall improvement in cognitive function, including memory, following completion of treatment.[44]

rTMS

rTMS (repetitive transcranial magnetic stimulation) is gradually becoming recognised as a valuable therapeutic option in treatment-resistant depression. It involves placing an electromagnetic coil near the head and stimulating the nerves in the areas of the brain that play a role in mood regulation and depression.[45] A number of randomised placebo-controlled trials have compared real versus sham rTMS. These trials have consistently demonstrated the efficacy of this treatment against major depression. There have also been a number of meta-analyses of RCTs[46] confirming the efficacy of rTMS in treatment-resistant major depression, as well as naturalistic studies showing its effectiveness in "real world" clinical settings.[47][48] While effective, it is also generally tolerated well with very few side effects.

dTMS

dTMS (deep transcranial magnetic stimulation) is a continuation of the same idea as rTMS, but with the hope that deeper stimulation of subcortical areas of the brain leads to increased effect.[49] A 2015 systematic review and health technology assessment found lacking evidence in order to recommend the method over either ECT or rTMS because so few studies had been published.[49]

Vagus nerve stimulation

Vagus nerve stimulation has also been used for treatment-resistant depression.[50] While more studies are needed to better understand its effect, a meta analysis found evidence that it may provide some benefit to individuals struggling with treatment-resistance.[51]

Deep brain stimulation

Deep brain stimulation has been used in a small number of clinical trials to treat people with severe treatment-resistant depression.[52]

Magnetic seizure therapy

Magnetic seizure therapy is currently being investigated for treating refractory depression.

Transcranial direct-current stimulation

Transcranial direct-current stimulation is a form of neuromodulation that uses constant, low direct current delivered via electrodes on the head.

Psychotherapy

There is sparse evidence on the effectiveness of psychotherapy in cases of treatment-resistant depression.[12] However, a review of the literature suggests that it may be an effective treatment option.[53][54] Psychotherapy may be effective in people with treatment-resistant depression because it can help relieve stress that may contribute to depressive symptoms.[55]

A Cochrane systematic review has shown that psychological therapies (including cognitive behavioural therapy, dialectical behavior therapy, interpersonal therapy and intensive short-term dynamic psychotherapy) added to usual care (with antidepressants) can be beneficial for depressive symptoms and for response and remission rates over the short term (up to six months) for patients with treatment-resistant depression. Medium- (7–12 months) and long‐term (longer than 12 months) effects seem similarly beneficial. Psychological therapies, including cognitive behavioral therapy, added to usual care (antidepressants) seem as acceptable as usual care alone and may be used as a first line treatment for mild to moderate treatment resistant depression.[56][32] These findings were echoed by another systematic review finding improved response and remission rates for CBT over the short, medium, and long-term.[57]

Outcomes

Treatment-resistant depression is associated with more instances of relapse than depression that is responsive to treatment. One study showed that as many as 80% of people with treatment-resistant depression who needed more than one course of treatment relapsed within a year. Treatment-resistant depression has also been associated with lower long-term quality of life.[58] Individuals struggling with treatment-resistant depression report lower work productivity, higher rates of unemployment, and difficulty completing daily tasks when compared to the general population.[11]

While we defined treatment resistance as failing to respond to at least two antidepressants, we know that as you try the third and fourth medication, there is even a higher likelihood of resistance and therefore, depression recurrence.[6] This is evidenced by a study that saw just 8 of 124 patients in remission after two years of standard depression treatment.[59] This can lead to significant hardships for the individuals struggling with treatment resistance as outlined in the paragraph above.

References

  1. ^ Wijeratne C, Sachdev P (September 2008). "Treatment-resistant depression: critique of current approaches". The Australian and New Zealand Journal of Psychiatry. 42 (9): 751–762. doi:10.1080/00048670802277206. PMID 18696279. S2CID 2848646.
  2. ^ a b Sforzini L, Worrell C, Kose M, Anderson IM, Aouizerate B, Arolt V, et al. (March 2022). "A Delphi-method-based consensus guideline for definition of treatment-resistant depression for clinical trials". Molecular Psychiatry. 27 (3): 1286–1299. doi:10.1038/s41380-021-01381-x. PMC 9095475. PMID 34907394.
  3. ^ Malhi GS, Das P, Mannie Z, Irwin L (January 2019). "Treatment-resistant depression: problematic illness or a problem in our approach?". The British Journal of Psychiatry. 214 (1): 1–3. doi:10.1192/bjp.2018.246. PMID 30565539. failure to respond is often the result of administering inappropriate treatment, which occurs principally because of paradigm failure
  4. ^ Rost F, Booker T, Gonsard A, de Felice G, Asseburg L, Malda-Castillo J, et al. (August 2024). "The complexity of treatment-resistant depression: A data-driven approach". Journal of Affective Disorders. 358: 292–301. doi:10.1016/j.jad.2024.04.093. PMID 38697222. Our findings reveal a complex and multifaceted condition and call for an urgent reconceptualization of TRD, which encompasses many interdependent variables and experiences.
  5. ^ Scott F, Hampsey E, Gnanapragasam S, Carter B, Marwood L, Taylor RW, et al. (March 2023). "Systematic review and meta-analysis of augmentation and combination treatments for early-stage treatment-resistant depression". Journal of Psychopharmacology. 37 (3): 268–278. doi:10.1177/02698811221104058. PMC 10076341. PMID 35861202.
  6. ^ a b Rush AJ, Trivedi MH, Wisniewski SR, Nierenberg AA, Stewart JW, Warden D, et al. (November 2006). "Acute and longer-term outcomes in depressed outpatients requiring one or several treatment steps: a STAR*D report". The American Journal of Psychiatry. 163 (11): 1905–1917. doi:10.1176/ajp.2006.163.11.1905. PMID 17074942.
  7. ^ a b Berman RM, Narasimhan M, Charney DS (1997). "Treatment-refractory depression: definitions and characteristics". Depression and Anxiety. 5 (4): 154–164. doi:10.1002/(sici)1520-6394(1997)5:4<154::aid-da2>3.0.co;2-d. PMID 9338108. S2CID 33974050.
  8. ^ Voineskos D, Daskalakis ZJ, Blumberger DM (2020-01-21). "Management of Treatment-Resistant Depression: Challenges and Strategies". Neuropsychiatric Disease and Treatment. 16: 221–234. doi:10.2147/ndt.s198774. PMC 6982454. PMID 32021216.
  9. ^ Sternat T, Katzman MA (2016-08-25). "Neurobiology of hedonic tone: the relationship between treatment-resistant depression, attention-deficit hyperactivity disorder, and substance abuse". Neuropsychiatric Disease and Treatment. 12: 2149–2164. doi:10.2147/NDT.S111818. PMC 5003599. PMID 27601909.
  10. ^ a b Kornstein SG, Schneider RK (2001). "Clinical features of treatment-resistant depression". The Journal of Clinical Psychiatry. 62 (Suppl 16): 18–25. PMID 11480880.
  11. ^ a b c O'Connor SJ, Hewitt N, Kuc J, Orsini L (2023-11-13). "Predictors and Risk Factors of Treatment-Resistant Depression: A Systematic Review". The Journal of Clinical Psychiatry. 85 (1). doi:10.4088/JCP.23r14885. ISSN 1555-2101. PMID 37967334.
  12. ^ a b Thase ME, Kasper S, Montgomery S (2013). Treatment-resistant Depression - The Role of Psychotherapy in the Management of Treatment-resistant Depression. pp. 183–208. doi:10.1002/9781118556719. ISBN 9781118556719.
  13. ^ Gronemann FH, Jorgensen MB, Nordentoft M, Andersen PK, Osler M (2020-01-15). "Socio-demographic and clinical risk factors of treatment-resistant depression: A Danish population-based cohort study". Journal of Affective Disorders. 261: 221–229. doi:10.1016/j.jad.2019.10.005. PMID 31655377.
  14. ^ Döme P, Kunovszki P, Takács P, Fehér L, Balázs T, Dede K, et al. (2021-01-20). Hashimoto K (ed.). "Clinical characteristics of treatment-resistant depression in adults in Hungary: Real-world evidence from a 7-year-long retrospective data analysis". PLOS ONE. 16 (1): e0245510. Bibcode:2021PLoSO..1645510D. doi:10.1371/journal.pone.0245510. ISSN 1932-6203. PMC 7817060. PMID 33471854.
  15. ^ Andrews LW (2010). Encyclopedia of depression. Santa Barbara, Calif: Greenwood Press. [page needed]
  16. ^ a b Shelton RC, Osuntokun O, Heinloth AN, Corya SA (February 2010). "Therapeutic options for treatment-resistant depression". CNS Drugs. 24 (2): 131–161. doi:10.2165/11530280-000000000-00000. PMID 20088620. S2CID 32936223.
  17. ^ Friedman ES, Anderson IM (2011). Managing depression in clinical practice. London: Springer. page 81
  18. ^ Abdallah CG, Sanacora G, Duman RS, Krystal JH (2015). "Ketamine and rapid-acting antidepressants: a window into a new neurobiology for mood disorder therapeutics". Annual Review of Medicine. 66: 509–523. doi:10.1146/annurev-med-053013-062946. PMC 4428310. PMID 25341010.
  19. ^ Serafini G, Howland RH, Rovedi F, Girardi P, Amore M (September 2014). "The role of ketamine in treatment-resistant depression: a systematic review". Current Neuropharmacology. 12 (5): 444–461. doi:10.2174/1570159X12666140619204251. PMC 4243034. PMID 25426012.
  20. ^ McIntyre RS, Rosenblat JD, Nemeroff CB, Sanacora G, Murrough JW, Berk M, et al. (May 2021). "Synthesizing the Evidence for Ketamine and Esketamine in Treatment-Resistant Depression: An International Expert Opinion on the Available Evidence and Implementation". The American Journal of Psychiatry. 178 (5). American Psychiatric Association Publishing: 383–399. doi:10.1176/appi.ajp.2020.20081251. PMC 9635017. PMID 33726522.
  21. ^ Bahr R, Lopez A, Rey JA (June 2019). "Intranasal Esketamine (Spravato) for Use in Treatment-Resistant Depression In Conjunction With an Oral Antidepressant". P & T. 44 (6): 340–375. PMC 6534172. PMID 31160868.
  22. ^ Sathyanarayana Rao T, Andrade C (2017). "A possible role for ketamine in suicide prevention in emergency and mainstream psychiatry". Indian Journal of Psychiatry. 59 (3): 259. doi:10.4103/psychiatry.IndianJPsychiatry_345_17. ISSN 0019-5545. PMC 5659073. PMID 29085082.
  23. ^ Alnefeesi Y, Chen-Li D, Krane E, Jawad MY, Rodrigues NB, Ceban F, et al. (2022-05-25). "Real-world effectiveness of ketamine in treatment-resistant depression: A systematic review & meta-analysis". Journal of Psychiatric Research. 151: 693–709. doi:10.1016/j.jpsychires.2022.04.037. PMID 35688035.
  24. ^ a b c d e Davies P, Ijaz S, Williams CJ, Kessler D, Lewis G, Wiles N (December 2019). "Pharmacological interventions for treatment-resistant depression in adults". The Cochrane Database of Systematic Reviews. 12 (12): CD010557. doi:10.1002/14651858.CD010557.pub2. PMC 6916711. PMID 31846068.
  25. ^ Ruhé HG, Huyser J, Swinkels JA, Schene AH (December 2006). "Switching antidepressants after a first selective serotonin reuptake inhibitor in major depressive disorder: a systematic review". The Journal of Clinical Psychiatry. 67 (12): 1836–1855. doi:10.4088/JCP.v67n1203. PMID 17194261. S2CID 9758110.
  26. ^ Corp SA, Gitlin MJ, Altshuler LL (2014-09-25). "A Review of the Use of Stimulants and Stimulant Alternatives in Treating Bipolar Depression and Major Depressive Disorder". The Journal of Clinical Psychiatry. 75 (09): 1010–1018. doi:10.4088/JCP.13r08851. ISSN 0160-6689.
  27. ^ Orr K, Taylor D (2007). "Psychostimulants in the Treatment of Depression: A Review of the Evidence". CNS Drugs. 21 (3): 239–257. doi:10.2165/00023210-200721030-00004. ISSN 1172-7047.
  28. ^ Mariani JJ, Levin FR (2007-01-02). "Treatment Strategies for Co‐Occurring ADHD and Substance Use Disorders". The American Journal on Addictions. 16 (s1): 45–56. doi:10.1080/10550490601082783. ISSN 1055-0496. PMC 2676785. PMID 17453606.
  29. ^ Zhang L, Yao H, Li L, Du Rietz E, Andell P, Garcia-Argibay M, et al. (2022-11-23). "Risk of Cardiovascular Diseases Associated With Medications Used in Attention-Deficit/Hyperactivity Disorder: A Systematic Review and Meta-analysis". JAMA Network Open. 5 (11): e2243597. doi:10.1001/jamanetworkopen.2022.43597. ISSN 2574-3805. PMC 9685490. PMID 36416824.
  30. ^ Farzam K, Faizy RM, Saadabadi A (2025), "Stimulants", StatPearls, Treasure Island (FL): StatPearls Publishing, PMID 30969718, retrieved 2025-03-24
  31. ^ Crossley NA, Bauer M (June 2007). "Acceleration and augmentation of antidepressants with lithium for depressive disorders: two meta-analyses of randomized, placebo-controlled trials". The Journal of Clinical Psychiatry. 68 (6): 935–940. doi:10.4088/jcp.v68n0617. PMID 17592920.
  32. ^ a b c Steffens DC (February 2024). "Treatment-Resistant Depression in Older Adults". The New England Journal of Medicine. 390 (7): 630–639. doi:10.1056/NEJMcp2305428. PMC 10885705. PMID 38354142.
  33. ^ Carvalho AF, Cavalcante JL, Castelo MS, Lima MC (October 2007). "Augmentation strategies for treatment-resistant depression: a literature review". Journal of Clinical Pharmacy and Therapeutics. 32 (5): 415–428. doi:10.1111/j.1365-2710.2007.00846.x. PMID 17875106.
  34. ^ Stead LG, Stead SM, Kaufman MS, Melin GJ (2005). First aid for the psychiatry clerkship: a student-to-student guide. New York: McGraw-Hill. p. 140. ISBN 978-0-07-144872-7.
  35. ^ Palhano-Fontes F, Barreto D, Onias H, Andrade KC, Novaes MM, Pessoa JA, et al. (March 2019). "Rapid antidepressant effects of the psychedelic ayahuasca in treatment-resistant depression: a randomized placebo-controlled trial". Psychological Medicine. 49 (4): 655–663. doi:10.1017/S0033291718001356. PMC 6378413. PMID 29903051.
  36. ^ Barros de Araujo D (15 February 2017). "Antidepressant Effects of Ayahuasca: a Randomized Placebo Controlled Trial in Treatment Resistant Depression - Full Text View - ClinicalTrials.gov". clinicaltrials.gov.
  37. ^ "COMPASS Pathways Receives FDA Breakthrough Therapy Designation for Psilocybin Therapy for Treatment-resistant Depression". Compass Pathways. Archived from the original on December 4, 2018. Retrieved 2018-12-03.
  38. ^ Staines R (2 December 2019). "FDA tags psilocybin drug as clinical depression Breakthrough Therapy". Pharmaphorum. Archived from the original on September 7, 2021. Retrieved 7 September 2021.
  39. ^ Więckiewicz G, Stokłosa I, Piegza M, Gorczyca P, Pudlo R (August 2021). "Lysergic Acid Diethylamide, Psilocybin and Dimethyltryptamine in Depression Treatment: A Systematic Review". Pharmaceuticals. 14 (8): 793. doi:10.3390/ph14080793. PMC 8399008. PMID 34451890.
  40. ^ Fink M (2009). Electroconvulsive therapy: A guide for professionals and their patients. Oxford: Oxford University Press. [page needed]
  41. ^ a b Trifu S, Sevcenco A, Stănescu M, Drăgoi A, Cristea M (2021-09-09). "Efficacy of electroconvulsive therapy as a potential first‑choice treatment in treatment‑resistant depression (Review)". Experimental and Therapeutic Medicine. 22 (5). doi:10.3892/etm.2021.10716. ISSN 1792-0981. PMC 8461517. PMID 34630636.
  42. ^ Baldinger P, Lotan A, Frey R, Kasper S, Lerer B, Lanzenberger R (2014-06-01). "Neurotransmitters and Electroconvulsive Therapy". The Journal of ECT. 30 (2): 116–121. doi:10.1097/YCT.0000000000000138. ISSN 1095-0680.
  43. ^ Zhang X, Zhang Z, Sha W, Xie C, Xi G, Zhou H, et al. (December 2009). "Electroconvulsive therapy increases glial cell-line derived neurotrophic factor (GDNF) serum levels in patients with drug-resistant depression". Psychiatry Research. 170 (2–3): 273–275. doi:10.1016/j.psychres.2009.01.011. PMID 19896212. S2CID 3392108.
  44. ^ Semkovska M, McLoughlin DM (2010-09-15). "Objective Cognitive Performance Associated with Electroconvulsive Therapy for Depression: A Systematic Review and Meta-Analysis". Biological Psychiatry. 68 (6): 568–577. doi:10.1016/j.biopsych.2010.06.009. ISSN 0006-3223.
  45. ^ Gaynes BN, Lloyd SW, Lux L, Gartlehner G, Hansen RA, Brode S, et al. (2014-05-15). "Repetitive Transcranial Magnetic Stimulation for Treatment-Resistant Depression: A Systematic Review and Meta-Analysis". The Journal of Clinical Psychiatry. 75 (05): 477–489. doi:10.4088/JCP.13r08815. ISSN 0160-6689.
  46. ^ Hovington CL, McGirr A, Lepage M, Berlim MT (June 2013). "Repetitive transcranial magnetic stimulation (rTMS) for treating major depression and schizophrenia: a systematic review of recent meta-analyses". Annals of Medicine. 45 (4): 308–321. doi:10.3109/07853890.2013.783993. PMID 23687987. S2CID 46443378.
  47. ^ Carpenter LL, Janicak PG, Aaronson ST, Boyadjis T, Brock DG, Cook IA, et al. (July 2012). "Transcranial magnetic stimulation (TMS) for major depression: a multisite, naturalistic, observational study of acute treatment outcomes in clinical practice". Depression and Anxiety. 29 (7): 587–596. doi:10.1002/da.21969. PMID 22689344. S2CID 22968810.
  48. ^ Euba R, Panihhidina I, Zamar A (2015). "Treatment-resistant depression: the experience of the first rTMS Clinic in the UK". Future Neurology. 10 (3): 211–215. doi:10.2217/fnl.15.8.
  49. ^ a b "Effekter av djup transkraniell magnetstimulering med H-spole". Statens beredning för medicinsk och social utvärdering (SBU) [Swedish Agency for Health Technology Assessment and Assessment of Social Services] (in Swedish). October 2015. Retrieved 2017-06-02.
  50. ^ Carreno FR, Frazer A (July 2017). "Vagal Nerve Stimulation for Treatment-Resistant Depression". Neurotherapeutics. 14 (3): 716–727. doi:10.1007/s13311-017-0537-8. PMC 5509631. PMID 28585221.
  51. ^ Bottomley JM, LeReun C, Diamantopoulos A, Mitchell S, Gaynes BN (2020-04-01). "Vagus nerve stimulation (VNS) therapy in patients with treatment resistant depression: A systematic review and meta-analysis". Comprehensive Psychiatry. 98: 152156. doi:10.1016/j.comppsych.2019.152156. ISSN 0010-440X.
  52. ^ Anderson RJ, Frye MA, Abulseoud OA, Lee KH, McGillivray JA, Berk M, et al. (September 2012). "Deep brain stimulation for treatment-resistant depression: efficacy, safety and mechanisms of action". Neuroscience and Biobehavioral Reviews. 36 (8): 1920–1933. doi:10.1016/j.neubiorev.2012.06.001. PMID 22721950. S2CID 207089716.
  53. ^ Trivedi RB, Nieuwsma JA, Williams JW (June 2011). "Examination of the utility of psychotherapy for patients with treatment resistant depression: a systematic review". Journal of General Internal Medicine. 26 (6): 643–650. doi:10.1007/s11606-010-1608-2. PMC 3101965. PMID 21184287.
  54. ^ van Bronswijk S, Moopen N, Beijers L, Ruhe HG, Peeters F (2018-08-24). "Effectiveness of psychotherapy for treatment-resistant depression: a meta-analysis and meta-regression". Psychological Medicine. 49 (3): 366–379. doi:10.1017/S003329171800199X. ISSN 0033-2917.
  55. ^ Greden J, Riba M, McInnis M (2011). Treatment resistant depression: A roadmap for effective care. Arlington, VA: American Psychiatric Publishing. [page needed]
  56. ^ Ijaz S, Davies P, Williams CJ, Kessler D, Lewis G, Wiles N (May 2018). "Psychological therapies for treatment-resistant depression in adults". The Cochrane Database of Systematic Reviews. 5 (5): CD010558. doi:10.1002/14651858.CD010558.pub2. PMC 6494651. PMID 29761488.
  57. ^ Li JM, Zhang Y, Su WJ, Liu LL, Gong H, Peng W, et al. (2018-10-01). "Cognitive behavioral therapy for treatment-resistant depression: A systematic review and meta-analysis". Psychiatry Research. 268: 243–250. doi:10.1016/j.psychres.2018.07.020. ISSN 0165-1781.
  58. ^ Fekadu A, Wooderson SC, Markopoulo K, Donaldson C, Papadopoulos A, Cleare AJ (July 2009). "What happens to patients with treatment-resistant depression? A systematic review of medium to long term outcome studies". Journal of Affective Disorders. 116 (1–2): 4–11. doi:10.1016/j.jad.2008.10.014. PMID 19007996.
  59. ^ "APA PsycNet".

Notes

This article is a direct transclusion of the Wikipedia article and therefore may not meet the same editing standards as LIMSwiki.

Retrieved from "https://test.limswiki.org/index.php?title=Treatment-resistant_depression&oldid=24589"