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Home » Bipolar Disorder

Psychiatric Times. Vol. 23 No. 11
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Treatment-Resistant Depression: Strategies for Management

By Alicia R. Ruelaz, MD | October 1, 2006

[Note: Medications used for treatment-resistant depression may not be FDA-approved for that purpose.]

Dr Ruelaz is a faculty psychiatrist of the consultation-liaison division in the department of psychiatry and behavioral neurosciences at Cedars Sinai Medical Center in Los Angeles. She reports that she has no conflicts of interest concerning the subject matter of this article.

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Drugs Mentioned in This Article
Bupropion (Wellbutrin)
Buspirone (BuSpar)
Citalopram (Celexa)
Desipramine (Norpramin; Pertofrane)
Dextroamphetamine (Dexedrine)
Duloxetine (Cymbalta)
Fluoxetine (Prozac)
Inositol
Lithium (Eskalith)
Methylphenidate (Concerta, Ritalin)
Mirtazapine (Remeron)
Modafinil (Provigil)
Nefazodone (Serzone)
Nortriptyline (Aventyl, Pamelor)
Olanzapine (Zyprexa)
Pindolol (Visken)
Risperidone (Risperdal)
Sertraline (Zoloft)
Triiodothyronine (Liothyronine, Cytomel)
Venlafaxine (Effexor)

Evidence-based References

  • Rush AJ, Trivedi MH, Wisniewski SR, et al, for the STAR*D Study Team. Bupropion-SR, sertraline, or venlafaxine-XR after failure of SSRIs for depression. N Engl J Med. 2006;354:1231-1242.
  • Trivedi MH, Fava M, Wisniewski SR, et al, for the STAR*D Study Team. Medication augmentation after the failure of SSRIs for depression. N Engl J Med. 2006;354: 1243-1252.

References:

1. Thase ME, Rush AJ. When at first you don't succeed: sequential strategies for antidepressant nonresponders. J Clin Psychiatry. 1997;58(suppl 13):23-29.
2. Thase ME, Howland RH, Friedman ES. Treating antidepressant nonresponders with augmentation strategies: an overview. J Clin Psychiatry. 1998;59(suppl 5): 5-12.
3. Thase ME Therapeutic alternatives for difficult-to-treat depression: a narrative review of the state of the evidence? CNS Spectr. 2004;9:808-821.
4. Gotto J, Rapaport MH Treatment options in treatment resistant depression. Primary Psychiatry [serial online]. 2005. Available at: http://www.primarypsychiatry.com/aspx/articledetail.aspx?articleid=254. Accessed September 18, 2006.
5. Fava M, Rosenbaum JF, McGrath PJ, et al. Lithium and tricyclic augmentation of fluoxetine treatment for resistant major depression: a double-blind, controlled study. Am J Psychiatry. 1994;151:1372-1374.
6. Charney DS, Nelson JC. Delusional and nondelusional unipolar depression: further evidence for distinct subtypes. Am J Psychiatry. 1981;138:328-333.
7. Thase M. New approaches to managing difficult-to-treat depressions. J Clin Psychiatry. 2003;64(suppl 1): 3-4.
8. Nelson JC. Managing treatment resistant major depression. J Clin Psychiatry. 2003;64(suppl 1):5-12.
9. Rush AJ, Trivedi MH, Wisniewski SR, et al, for the STAR*D Study Team. Bupropion-SR, sertraline, or venlafaxine-XR after failure of SSRIs for depression. N Engl J Med. 2006;354:1231-1242.
10. Nemeroff CB. Augmentation strategies in patients with refractory depression. Depress Anxiety. 1996-1997; 4:169-181.
11. Joffe RT, Levitt AJ, Sokolov ST. Augmentation strategies: focus on anxiolytics. J Clin Psychiatry. 1996;57 (suppl 7):25-31.
12. Gitlin MJ, Weiner H, Fairbanks L, et al. Failure of T3 to potentiate tricyclic antidepressant response. J Affect Disord. 1987;13:267-272.
13. Nelson JC. Treatment of antidepressant nonresponders: augmentation of switch? J Clin Psychiatry. 1998;59(suppl 15):35-41.
14. Bodkin JA, Lasser RA, Wines JD Jr, et al. Combining serotonin reuptake inhibitors and bupropion in partial responders to antidepressant monotherapy. J Clin Psychiatry. 1997;58:137-145.
15. Carpenter LL, Yasmin S, Price LH. A double-blind, placebo-controlled study of antidepressant augmentation with mirtazapine. Biol Psychiatry. 2002;51: 183-188.
16. Fava M, Thase M, DeBattista C. Modafinil as antidepressant augmentation therapy in major depressive disorder. Presented at: 157th Annual Meeting of the American Psychiatric Association; May 1-6, 2004; New York.
17. Landen M, Bjorling G, Agren H, Fahlen T. A randomized, double-blind, placebo-controlled trial of buspirone in combination with an SSRI in patients with treatment-refractory depression. J Clin Psychiatry. 1998;59: 664-668.
18. Appelberg BG, Syvalahti EK, Koskinen TE, et al. Patients with severe depression may benefit from buspirone augmentation of selective serotonin reuptake inhibitors: results from a placebo-controlled, randomized, double-blind, placebo wash-in study. J Clin Psychiatry. 2001;62:448-452.
19. Trivedi MH, Fava M, Wisniewski SR, et al, for the STAR*D Study Team. Medication augmentation after the failure of SSRIs for depression. N Engl J Med. 2006; 354:1243-1252.
20. Zhang W, Perry KW, Wong DT, et al. Synergistic effects of olanzapine and other antipsychotic agents in combination with fluoxetine on norepinephrine and dopamine release in rat prefrontal cortex. Neuropsychopharmacology. 2000;23:250-262.
21. Shelton RC, Tollefson GD, Tohen M, et al. A novel augmentation strategy for treating resistant major depression. Am J Psychiatry. 2001;158:131-134.
22. Rapaport MH, Gharabawi GM, Canuso CM, et al. Effects of risperidone augmentation in patients with treatment-resistant depression: results of open-label treatment followed by double-blind continuation. Neuropsychopharmacology. 2006; Jun 7; [Epub ahead of print].
23. Dunner DL, Amsterdam JD, Shelton RC, et al. Adjunctive ziprasidone in treatment-resistant depression: a pilot study. Presented at: American Psychiatric Association Annual Meeting; May 17-22, 2003; San Francisco.
24. Wright JH. Cognitive-behavior therapy for chronic depression. Psychiatr Ann. 2003;33:777-784.
25. Jarrett RB, Kraft D, Doyle J, et al. Preventing recurrent depression using cognitive therapy with and without a continuation phase: a randomized clinical trial. Arch Gen Psychiatry. 2001;58:381-388.
26. Paykel ES, Scott J, Teasdale JD, et al. Prevention of relapse in residual depression by cognitive therapy: a controlled trial. Arch Gen Psychiatry. 1999;56: 829-835.
27. Keller MB, McCullough JP, Klein DN, et al. A comparison of nefazodone, the cognitive behavioral-analysis system of psychotherapy, and their combination for the treatment of chronic depression. N Engl J Med. 2000; 342:1462-1470.
28. Gange GG Jr, Furman MJ, Carpenter LL, Price LH. Efficacy of continuation ECT and antidepressant drugs compared to long-term antidepressants alone in depressed patients. Am J Psychiatry. 2000;157: 1960-1965.
29. Boutros NN, Gueorquieva R, Hoffman RE, et al. Lack of a therapeutic effect of a 2-week subthreshold transcranial magnetic stimulation course for treatment-resistant depression. Psychiatry Res. 2002;113: 245-254.
30. Levitt JA, Joffe RT, Kennedy SH. Bright-light augmentation in antidepressant non-responders. J Clin Psychiatry. 1991;52:336-337.


 
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