Showing papers on "Treatment-resistant depression published in 2000"

Childhood emotional trauma and chronic posttraumatic stress disorder in adult outpatients with treatment-resistant depression.

Abstract: The intent of this study was to test the hypothesis that patients with treatment-resistant depression are more likely than treatment responsive patients to suffer from sequelae of childhood trauma that may perpetuate depression despite adequate medication treatment. Twenty participants with treatment-resistant depression and 20 participants with treatment-responsive depression were administered a structured interview and a battery of psychological tests to assess levels of current depression, confirm diagnosis, and quantify childhood trauma and presence of dissociative phenomena. Tests used include the Beck Depression Inventory, the Mini International Neuropsychiatric Interview, the Minnesota Multiphasic Personality Inventory-2, the Childhood Trauma Questionnaire, and the Trauma Symptom Inventory. Compared with treatment responders, the treatment-resistant participants were significantly more depressed, had significantly more comorbid anxiety disorders, reported significantly greater levels of childhood emotional abuse, and experienced current-day sequelae of childhood emotional abuse. The hypothesis was partially supported by these results. This study suggests that reported history of childhood emotional abuse and sequelae of that abuse may be associated with treatment resistance in depressed outpatients.

Use of slow-release melatonin in treatment-resistant depression.

Abstract: OBJECTIVE: To examine antidepressant augmentation with and hypnotic effects of slow-release melatonin (SR-melatonin) in patients with treatment-resistant depression. DESIGN: Open-label trial. SETTING: Tertiary care outpatient depression clinic. PATIENTS: Nine outpatients who had failed to respond to 2 or more 8-week trials of antidepressant medication. INTERVENTIONS: Patients received SR-melatonin 5 mg per day for the first 2 weeks and 10 mg per day for the final 2 weeks, in addition to their antidepressant medication. OUTCOME MEASURES: Structured Clinical Interview for DSM-IV, Axis 1 Disorders, Hamilton Rating Scale for Depression (HRSD), Beck Depression Inventory, Response Style Questionnaire, sleep and fatigue measures. RESULTS: One patient was excluded after 1 week because of the development of a mixed affective state. In the remaining 8 patients there was a 20% mean decrease in HRSD scores after 4 weeks of treatment, with no individual achieving an improvement of 50% or more. There was a 36% decrease on the 3-item HRSD related to insomnia, with 4 of 8 patients showing at least a 50% improvement on this measure. The greatest decrease in insomnia occurred during the last 2 weeks of the study, following the increase in dosage to 10 mg per day of SR-melatonin. Patients also reported significantly lower levels of fatigue post-treatment. CONCLUSIONS: SR-melatonin may be a useful adjunct for sleep, but does not substantially augment existing antidepressant therapies in some patients with treatment-resistant depression.

Strategies for Managing Depression Refractory to Selective Serotonin Reuptake Inhibitor Treatment: A Survey of Clinicians

Abstract: Objective:To examine treatment practices in cases where selective serotonin reuptake inhibitors (SSRIs) are ineffective.Methods:We surveyed 801 clinicians (including 630 psychiatrists) attending th...

Prednisone augmentation in treatment-resistant depression with fatigue and hypocortisolaemia: A case series

Abstract: Abnormalities of the hypothalamic-pituitary-adrenal (HPA) axis have long been implicated in major depression with hypercortisolaemia reported in typical depression and hypocortisolaemia in some studies of atypical depression. We report on the use of prednisone in treatment-resistant depressed patients with reduced plasma cortisol concentrations. Six patients with treatment-resistant major depression were found to complain of severe fatigue, consistent with major depression, atypical subtype, and to demonstrate low plasma cortisol levels. Prednisone 7.5 mg daily was added to the antidepressant regime. Five of six patients demonstrated significant improvement in depression on prednisone augmentation of antidepressant therapy. Although hypercortisolaemia has been implicated in some patients with depression, our findings suggest that hypocortisolaemia may also play a role in some subtypes of this disorder. In treatment-resistant depressed patients with fatigue and hypocortisolaemia, prednisone augmentation may be useful.

Venlafaxine and treatment-resistant depression.

Abstract: Treatment-resistant depression (TRD) is an important clinical problem. This paper briefly reviews the definition of TRD and summarizes methodological issues that pertain to treatment research. Recent studies of venlafaxine treatment for TRD also are reviewed. It is concluded that venlafaxine at higher doses is a reasonably well-tolerated and an effective alternative for patients with TRD and typically should be used before tricyclic antidepressants or monoamine oxidase inhibitors. Further research is needed to confirm the prediction that switching a SSRI nonresponder to venlafaxine is a more effective strategy than switching to a second SSRI. The relative merits of switching from a SSRI to venlafaxine versus adding a norepinephrine reuptake inhibitor also warrant careful study.

[L-tryptophan plasma levels in treatment resistant depressive states].

Abstract: 10 to 30% of depressions are resistant to standard treatment. Different therapeutic strategies are used to treat the resistant depressions. Therefore, before initiating an antidepressant treatment, it would be important to know which patients will probably not respond to a standard treatment. Numerous studies have shown that serotonin is involved in depressive illness and its synthesis in the brain is dependent on the availability of tryprophan from plasma. As tryptophan plasma level is decreased in depression, resistant depressions may also be characterized by alterations of tryptophan plasma level. 141 depressed patients were admitted in our psychiatric unit in Geneva between 1984 and 1990. 36 were diagnosed as treatment resistant depression. Although treatment resistant patients group had more women and a more severe score of depression on the AMDP-4 scale, we did not observe a significant difference in tryptophan plasma level compared to patients who respond to treatment.

Venlafaxine had higher response and remission rates than paroxetine in non-chronic treatment resistant depression

Abstract: Patients 123 patients (mean age 43 y, 72% women) with major depression (DSM-III-R) of < 8 months duration. Inclusion criteria were age 18–60 years, 17-item Hamilton Depression Rating Scale (HDRS) score >18 and resistance (Clinical Global Impression [CGI] scale improvement score of 3 at the second treatment) to 2 antidepressant treatments for the current depression (therapeutic dose for >4 wk, then an alternative antidepressant at an effective dose equivalent to clomipramine 100–150 mg for >4 or >2 weeks if discontinued because of safety problems). Exclusion criteria were use of study drugs during the current episode; use of anticoagulants, phenytoin, mood stabilisers, or electroconvulsive therapy; recent use of antipsychotics or monoamine oxidase inhibitors; nonaffective disorder; suicide ideation; treatment inhibiting organic disease; seizure disorders; psychoactive substance dependence; cardiac, renal, or hepatic disease; pregnancy; or lactation. Follow up was 87% (observed case analysis).