TY - JOUR
T1 - The hidden third
T2 - Improving outcome in treatment-resistant depression
AU - Schlaepfer, Thomas E.
AU - Ågren, Hans
AU - Monteleone, Palmiero
AU - Gasto, Cristobal
AU - Pitchot, William
AU - Rouillon, Frederick
AU - Nutt, David J.
AU - Kasper, Siegfried
N1 - Funding Information:
William Pitchot holds a research grant from AstraZeneca and acts as a consultant to Bristol-Myers Squibb and Otsuka Pharmaceutical, Servier, AstraZeneca, GlaxoSmithKline and Eli Lilly. He is a speaker for Bristol-Myers Squibb and Otsuka Pharmaceutical, Servier, AstraZeneca, GlaxoSmithKline, Eli Lilly, Lundbeck, Pfizer and Janssen Pharmaceutical. Furthermore, he accepts payment for speaking engagements at symposia supported by Eli Lilly and Bristol-Myers Squibb and Otsuka Pharmaceutical and also receives payment for travel and hospitality for these events.
Funding Information:
Hans Ågren receives grants from the Swedish Science Council and Västra Götaland County Council, and honoraria from Bristol-Myers Squibb and Otsuka Pharmaceutical, AstraZeneca, Lundbeck, Schering-Plough, Eli Lilly and GlaxoSmithKline. He is also an advisory board member for AstraZeneca, Lundbeck, Eli Lilly, Servier, Boehringer Ingelheim, Bristol-Myers Squibb and Otsuka Pharmaceutical.
PY - 2012/5
Y1 - 2012/5
N2 - Treatment-resistant depression (TRD) presents many challenges for both patients and physicians. This review aims to evaluate the current status of the field of TRD and reflects the main findings of a consensus meeting held in September 2009. Literature searches were also conducted using PubMed and EMBASE. Abstracts of the retrieved articles were reviewed independently by the authors for inclusion. Evaluation of the clinical evidence in TRD is complicated by the absence of a validated definition, and there is a need to move away from traditional definitions of remission based on severity of symptoms to one that includes normalisation of functioning. One potential way of improving treatment of TRD is through the use of predictive biomarkers and clinical variables. The advent of new treatments may also help by focusing on neurotransmitters other than serotonin. Strategies such as the switching of antidepressants, use of combination therapy with lithium, atypical antipsychotics and other pharmacological agents can improve outcomes, and techniques such as deep brain stimulation and vagus nerve stimulation have shown promising early results. Despite consistent advances in the pharmacotherapy of mood disorders in the last decade, high rates of TRD are still a challenging aspect of overall management.
AB - Treatment-resistant depression (TRD) presents many challenges for both patients and physicians. This review aims to evaluate the current status of the field of TRD and reflects the main findings of a consensus meeting held in September 2009. Literature searches were also conducted using PubMed and EMBASE. Abstracts of the retrieved articles were reviewed independently by the authors for inclusion. Evaluation of the clinical evidence in TRD is complicated by the absence of a validated definition, and there is a need to move away from traditional definitions of remission based on severity of symptoms to one that includes normalisation of functioning. One potential way of improving treatment of TRD is through the use of predictive biomarkers and clinical variables. The advent of new treatments may also help by focusing on neurotransmitters other than serotonin. Strategies such as the switching of antidepressants, use of combination therapy with lithium, atypical antipsychotics and other pharmacological agents can improve outcomes, and techniques such as deep brain stimulation and vagus nerve stimulation have shown promising early results. Despite consistent advances in the pharmacotherapy of mood disorders in the last decade, high rates of TRD are still a challenging aspect of overall management.
KW - Major depressive disorder
KW - outcomes
KW - remission
KW - treatment resistance
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U2 - 10.1177/0269881111431748
DO - 10.1177/0269881111431748
M3 - Review article
C2 - 22236505
AN - SCOPUS:84861818969
SN - 0269-8811
VL - 26
SP - 587
EP - 602
JO - Journal of Psychopharmacology
JF - Journal of Psychopharmacology
IS - 5
ER -