Showing papers on "Treatment-resistant depression published in 1993"

Identification of treatment-resistant depressives who respond favorably to carbamazepine.

Abstract: Thirteen depressed patients with documented histories of failure to respond to tricyclic antidepressant medications who reported multiple partial seizure like symptoms were given open trials of carbamazepine. Eleven of the 13 showed moderate to substantial improvement in affective status that was accompanied by significant mean changes on the Beck or Hamilton depression scales. In addition, the mean number of reported partial seizurelike symptoms decreased significantly with treatment. Dichotic word listening performance was the only neuropsychoogical variable that was impaired at baseline and was also the only cognitive performance that improved following treatment. These preliminary observations sugest that there is likely to be a subgroup of treatment-resistant, carbamazepine-resonsive deressives who can be identified by evaluating for the presence of multiple partial seizure-like symptoms.

Treatment resistant depression in a case of minor head injury: an electrophysiological hypothesis

Abstract: A relatively small but highly concordant literature suggests that manic depressive psychoses may include familial as well as nonfamilial subtypes. The latter, which appears to be an acquired form, follows brain injury of various etiology, displays EEG abnormalities and tends to respond well to anticonvulsant therapy. In this study we postulate an extension of this dichotomy to a larger spectrum of affective disorder, including milder but "treatment resistant" forms often associated with a high degree of dysfunction. Central to this hypothesis is information gathered from the longitudinal study of a well defined case in which precise clinical and electrophysiological data have been obtained at critical junctures. This data also leads us to suggest the existence of a latent vulnerability to psychosocial stressors in a subgroup of minor head injured patients. Once triggered, the resulting psychopathological state may be clinically indistinguishable from similar but etiologically distinct conditions. However, they respond poorly, if at all, to the treatments usually effective for mood disorders, often causing puzzlement and frustration among clinicians as well as mounting hopelessness in patients. This organic mood disorder subtype, which can be described as "neuro-sensitization mood disorder," may be identified by combining a thorough history, including perinatal events and putative brain injury, with electrophysiological data consisting of quantitative EEG (QEEG) in association with evoked potentials. In cases with positive findings, anticonvulsants such as carbamazepine, clonazepam and valproic acid can be a treatment of choice.

Long-Term Outcome of Treatment-Resistant Depression in Older Adults

Abstract: Seventeen elderly patients with treatment-resistant depression were reassessed 15 months and 4 years after treatment with an antidepressant agent or ECT. At 15 months 47% (seven of I 5) were clinically improved, and at the 4-year follow-up 71 % (1 0 of I 4) were improved. These results indicate that treatment-resistant depression may improve over time because of either the natural course of the illness or persistent treatment efforts. (Am J Psychiatry 1993; 150:1539-1540) W e previously described the 6-month and 4-year outcomes of older patients who participated in a naturalistic treatment study of major depression (1, 2). While the outcomes were generally favorable, we nevertheless identified a subgroup of patients whose depression was initially resistant to treatment. In this paper we report the long-term outcome of this subgroup of patients.