Showing papers on "Treatment-resistant depression published in 1999"
TL;DR: Lithium augmentation seems to be the treatment strategy in refractory depression that has been investigated most frequently in placebo-controlled, double-blind studies and is the first-choice treatment procedure for depressed patients who fail to respond to antidepressant monotherapy.
Abstract: The addition of lithium to the treatment regimens of previously nonresponding depressed patients has been repeatedly investigated in controlled studies. The authors undertook this meta-analysis to investigate the efficacy of lithium augmentation of conventional antidepressants. An attempt was made to identify all placebo-controlled trials of lithium augmentation in refractory depression. Only double-blind studies that involved participants who had been treated with lithium or placebo addition after not responding to conventional antidepressants were to be included in the meta-analysis. Further inclusion criteria were the use of accepted diagnostic criteria for depression and the use of response criteria based on the acceptable measurement of depression as an outcome variable. Studies were located by a search of the MEDLINE database, a search in the Cochrane Library, and an intensive search by hand of reviews on lithium augmentation. Nine of 11 placebo-controlled, double-blind studies were included in this meta-analysis. Aggregating three studies with a total of 110 patients that used a minimum lithium dose of 800 mg/day, or a dose sufficient to reach lithium serum levels of > or = 0.5 mEq/L, and a minimum treatment duration of 2 weeks, the authors found that the pooled odds ratio of response during lithium augmentation compared with the response during placebo treatment was 3.31 (95% confidence interval, 1.46-7.53). The corresponding relative response rate was 2.14 (95% confidence interval, 1.23-3.70), the absolute improvement in response rate was 27% (95% confidence interval, 9.8%-44.2%), and the number of patients needed to be treated to obtain one more responder was 3.7. Inclusion of six more studies that fulfilled inclusion criteria but which treated subjects with additional lithium for less than 2 weeks or with a lower lithium dose (total, 234 patients) resulted in even higher estimates. Lithium augmentation seems to be the treatment strategy in refractory depression that has been investigated most frequently in placebo-controlled, double-blind studies. The authors conclude from this meta-analysis that with respect to efficacy, lithium augmentation is the first-choice treatment procedure for depressed patients who fail to respond to antidepressant monotherapy.
261 citations
TL;DR: Venlafaxine showed some evidence of superiority to paroxetine in this difficult-to-treat patient population of patients with non-chronic treatment-resistant depression.
Abstract: BACKGROUND About one-third of patients fail to respond to initial antidepressant therapy, which suggests a need for more effective drugs.
AIMS To compare the efficacy and safety of venlafaxine and paroxetine in 122 patients with non-chronic treatment-resistant depression.
METHOD In-patients or out-patients satisfying DSM-III-R criteria for major depression in evolution for less than eight months, having a baseline HAM-D score > or = 18 and a HAM-D Item 3 score < 3 were eligible. Patients were required to have a history of resistance to two previous antidepressant treatments and a CGI improvement score of 3 at the beginning of treatment. Doses were adjusted to 200-300 mg/day for venlafaxine and 30-40 mg/day for paroxetine.
RESULTS For the observed-case analysis, the response rate was 51.9% for venlafaxine and 32.7% for paroxetine (P = 0.044), and a remission was achieved in 42.3% of venlafaxine-treated and 20.0% of paroxetine-treated patients (P = 0.01). The incidence of adverse effects was comparable between treatment groups.
CONCLUSIONS Venlafaxine showed some evidence of superiority to paroxetine in this difficult-to-treat patient population.
218 citations
TL;DR: Preliminary observations suggest that chromium may potentiate antidepressant pharmacotherapy for dysthymic disorder.
Abstract: Background Dysthymic disorder is a relatively common illness that is often treated with antidepressants. Compared with the study of major depression, there has been little systematic study of potentiation strategies for antidepressant-refractory dysthymic disorder. Method Following a patient's report of dramatic response to the addition of chromium supplementation to sertraline pharmacotherapy for dysthymic disorder (DSM-IV), the authors initiated a series of single-blind and open-label trials of chromium picolinate or chromium polynicotinate in the treatment of antidepressant-refractory dysthymic disorder. Results In a series of 5 patients, chromium supplementation led to remission of dysthymic symptoms. Single-blind substitution of other dietary supplements in each of the patients demonstrated specificity of response to chromium supplementation. Conclusion Preliminary observations suggest that chromium may potentiate antidepressant pharmacotherapy for dysthymic disorder. Controlled studies are indicated to test the validity of these initial observations.
64 citations
TL;DR: In the Li group, clinical improvement significantly correlated with decrease in thyroxine concentration and a decrease in cortisol level in Li responders and an increase in nonresponders was observed, suggesting a regulatory effect of Li on the hypothalamic-pituitary-adrenal axis activity.
Abstract: Fifty-nine patients with treatment-resistant depression were randomly allocated an addition of either lithium (Li; 31 patients) or carbamazepine (CBZ; 28 patients) to ongoing antidepressant treatment. The therapeutic efficacy of both strategies, assessed after 28 days, was not significantly different. In the Li group, clinical improvement significantly correlated with decrease in thyroxine concentration. Also, a decrease in cortisol level in Li responders and an increase in nonresponders was observed, suggesting a regulatory effect of Li on the hypothalamic-pituitary-adrenal axis activity. CBZ responders had lower baseline severity of depression than CBZ nonresponders and clinical improvement significantly correlated with increase in erythrocyte ATPase activity in the CBZ group.
57 citations
Journal Article•
TL;DR: It is concluded that the rapid onset of action (2-3 hours) after administration may help cover the therapeutic latency period of conventional antidepressants and probably potentiates their effect.
Abstract: The use of psychostimulants as an adjuvant therapy in treatment-resistant depression is not very common nowadays and has been the subject of much criticism. This article gives a brief review of the literature and reports on the findings from a retrospective study carried out in 65 depressed patients treated with psychostimulants (amphetamine and methylphenidate) in addition to conventional antidepressants. Thirty-eight out of 65 patients showed significant improvement, in particular with respect to energy mood, and psychomotor activity. The best response to psychostimulants was seen in inhibited types of depression and in combination with a tricyclic antidepressant. None of the patients developed drug dependency. The incidence of side effects was low, and agitation and restlessness improved with an additional short-term treatment with benzodiazepines. It is concluded that the rapid onset of action (2-3 hours) after administration may help cover the therapeutic latency period of conventional antidepressants and probably potentiates their effect. In view of their potential benefits in treatment-resistant depressive states, psychostimulants should be tried more often.
36 citations
TL;DR: To the authors' knowledge this is the first report of successful combination therapy with venlafaxine and bupropion in treatment of chronic recurrent and refractory major depression.
Abstract: OBJECTIVE:To report the therapeutic efficacy of venlafaxine and bupropion in a patient with treatment-refractory major depression.CASE SUMMARY:A 21-year-old white woman with chronic and recurrent major depression presented with lack of response to several antidepressants. On examination, the patient exhibited neurovegetative signs of depression, guilt feelings, and suicidal ideation. The patient was administered venlafaxine 75 mg three times daily. The dose was titrated to 150 mg three times daily over the next month. Later bupropion was instituted up to 100 mg three times daily over a four-month period. The patient responded favorably to combination therapy and has remained free of depression for approximately 23 months.DISCUSSION:Venlafaxine and bupropion are antidepressant agents with unique pharmacologic profiles, each effective in the treatment of depression. Recent data indicate that combinations of selective serotonin-reuptake inhibitors and bupropion can convert partial response to full response i...
27 citations
23 citations
TL;DR: S Severity of depression but not any peripheral thyroid hormone level was associated with stage of anti-depressant treatment resistance and stage of treatment resistance does not appear to be a factor in the variability in peripheral thyroid hormones levels in unipolar major depression.
21 citations
TL;DR: Practical strategies for treatment-resistant depression, including switching classes of antidepressant drugs, combination therapy, augmentation strategies, and somatic therapies, are incorporated into a treatment algorithm.
16 citations
TL;DR: Analysis of the experience with nefazodone therapy in a population with treatment-resistant depression and a high degree of psychiatric comorbidity suggests that approximately 50% of patients may have substantial response to treatment, with a smaller proportion having a more modest clinical response.
12 citations
TL;DR: A case of sequential anti‐stress medication in a patient with major depression resistant to amine‐reuptake inhibitors and its implications for treatment of depression are investigated.
Abstract: One of the predictive factors of treatment-resistant depression is the syndrome of relative insulin resistance, i.e. adipositas, mild hypertension and a family history of type-2 diabetes. Such a case is here reported with a good outcome to anti-stress medication, including ketoconazole and lithium.
Journal Article•
TL;DR: This case report describes the improvement obtained by using tranylcypromine in a patient of severe treatment resistant depression.
Abstract: This case report describes the improvement obtained by using tranylcypromine in a patient of severe treatment resistant depression. The adverse effects faced and steps taken to overcome them have also been discussed.
Journal Article•
TL;DR: A case of long standing depression which responded to reboxetine, a novel noradrenaline re-uptake inhibitor, is reported, highlighting the need to identify individual symptom patterns and the employment of new, more specific, drugs targeting the symptoms in question.
Abstract: The introduction of antidepressants constituted a breakthrough in the treatment of depression. Despite their success, a significant proportion of patients respond partially or not at all, with detrimental effects for their life. The identification of individual symptom patterns and the employment of new, more specific, drugs targeting the symptoms in question may lead to increased response rates, even in treatment resistant cases. We report a case of long standing depression which responded to reboxetine, a novel noradrenaline re-uptake inhibitor. (Int J Psych Clin Pract 1999; 3: 289-291).
TL;DR: Venlafaxine, a serotonin-noradrenaline reuptake inhibitor, has apparently been shown to be effective in treatment-resistant depressed patients in a controlled-case series and slightly superior to selective serotonin reptake inhibitors (SSRIs) in some controlled studies of general depressed patients.
Abstract: Venlafaxine, a serotonin-noradrenaline reuptake inhibitor, has apparently been shown to be effective in treatment-resistant depressed patients in a controlled-case series, and slightly superior to selective serotonin reuptake inhibitors (SSRIs) in some controlled studies of general depressed patients. This double-blind, randomized, multicenter study from …