Showing papers on "Treatment-resistant depression published in 1988"

Treatment strategy in depression. I. Non-tricyclic and selective reuptake inhibitors in resistant depression: a double-blind partial crossover study on the effects of oxaprotiline and fluvoxamine.

Abstract: Antidepressants are ineffective in about 30% of patients with major depression. Some authors then advise treatment of non-responders with (non-tricyclic) more selective reuptake inhibitors. In a double-blind, partial crossover study, 71 patients were selected for treatment during 4 weeks with oxaprotiline and/or fluvoxamine, two non-tricyclic antidepressants that are selective reuptake inhibitors or noradrenaline and serotonin respectively. All patients had failed to respond to earlier treatment with cyclic antidepressants during the current episode. Only 13% of the patients responded, with 27% of them responding to oxaprotiline and none to fluvoxamine. Moreover, a low response of 27% was also obtained in the crossover phase, which included all non-responders to the first treatment, oxaprotiline being effective in 39% and fluvoxamine in 10% of the patients. The results indicate that selective reuptake inhibitors are not an effective alternative for non-responders to other cyclic antidepressants and that non-responders to "noradrenergic" antidepressants do not appear to have much chance of responding to "serotonergic" antidepressants and vice versa.

Adjunct low dose lithium carbonate in treatment-resistant depression: a placebo-controlled study.

Abstract: Resistance to antidepressant therapy is a common clinical problem in the treatment of affective disorders. Adjunctive low dose lithium is a promising strategy based on biochemical models and encouraging clinical trials. After a mean duration of 9.2 months of conventional therapy, 16 healthy patients with treatment-resistant depression were treated for a minimum of 2 weeks with either adjunctive lithium or placebo using a double-blind design. We found no difference between the two groups in rate or degree of response. The two most dramatic responses occurred in patients treated with placebo, although 50% of patients treated with lithium had at least a partial response. The number of patients studied was clearly inadequate to avoid a type 2 error. The cumulative response rate reported in the literature of greater than 60%, however, suggests that lithium is indeed an effective adjunct in some patients with treatment-resistant depression. Our patients differed from those in other studies in that they were treated with a lower dose of lithium, the duration of conventional antidepressant therapy was longer, and, finally, they were less depressed and possibly depressed for a longer period. These differences may explain the comparable lithium and placebo responses in this study.

Treatment resistant depression: a clinical perspective.

Abstract: One hundred and fourteen patients with a diagnosis of "treatment resistant depression" (TRD) were assessed and treated at a Mood Disorders Clinic. Diagnostically, 52 (45.6%) subjects met criteria for bipolar disorder, 49 (42.9%) for recurrent depression, and 13 (11.4%) patients did not fulfill diagnostic criteria for affective disorder which explained their treatment resistance. With appropriate, individualized treatment, 59 of 98 (60.2%) patients had complete symptom remission based on clinical and psychometric ratings (initial Ham-D 26.7, final Ham-D 5.9). Eighteen of 98 patients had partial remission (final Ham-D 15.9) with vigorous pharmacological interventions, and 8 subjects exhibited "absolute" TRD (final Ham-D 23.4). The results suggest the value of specialized mood disorder services. The partial and absolute TRD's were more likely to be older, received more Axis II diagnoses, and had previous histories of drug or alcohol abuse.

Lithium augmentation for treatment-resistant depression in the elderly.

Abstract: Lithium has been used successfully to enhance the effectiveness of tricyclic and other antidepressants, monoamine oxidase inhibitors, and combinations of antipsychotics and antidepressants. The safety and efficacy of adding lithium to the treatment regimen was examined in 14 elderly patients with refractory depression. Seven of the 14 had a complete recovery, and three showed a partial response. Side effects, including peripheral weakness, severe fine tremor, and neurotoxicity, necessitated the discontinuation of lithium in three patients. In two other patients with side effects, lower dosages of lithium relieved their symptoms. Lithium augmentation appears to be a promising treatment for geriatric depressed patients who are unresponsive to or cannot tolerate other standard therapies.

The combination of lithium carbonate and an MAOI in refractory depressions

Abstract: Lithium combined with phenelzine alleviated the symptoms of four severely depressed patients. Previously, all four patients had failed to respond to tricyclic antidepressants, and three had not responded to monoamine oxidase inhibitors.

Pharmacological Management of Treatment-Resistant Depression

Abstract: Treatment-resistant depression might be considered as the failure of two families of antidepressant therapy given sequentially at sufficient dosage, for an adequate length of time and with continuous compliance. Patients with treatment-resistant depression should be assessed as though they were new referrals, and factors which may be contributing should be dealt with whenever possible. A sequence of therapies based on a tricyclic antidepressant and a monoamine oxidase inhibitor, each combined with putative adjuvant therapies, is proposed as a working model pending further studies and developments.