Management of Treatment-Resistant Depression: Challenges and Strategies

Daphne Voineskos, 1, 2 Zafiris J Daskalakis, 1, 2 Daniel M Blumberger 1, 2 1Centre for Addiction and Mental Health, Toronto, Ontario, Canada; 2Department of Psychiatry, University of Toronto, Toronto, Ontario, CanadaCorrespondence: Daniel M BlumbergerCentre for Addiction and Mental Health, 1001 Qu...

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Autores principales:	Voineskos D, Daskalakis ZJ, Blumberger DM
Formato:	article
Lenguaje:	EN
Publicado:	Dove Medical Press 2020
Materias:	major depressive disorder treatment resistant depression pharmacotherapy brain stimulation mood disorders Neurosciences. Biological psychiatry. Neuropsychiatry RC321-571 Neurology. Diseases of the nervous system RC346-429
Acceso en línea:	https://doaj.org/article/912b2c2cb46d40fe9cce81675290e46f
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spelling	oai:doaj.org-article:912b2c2cb46d40fe9cce81675290e46f2021-12-02T11:02:09ZManagement of Treatment-Resistant Depression: Challenges and Strategies1178-2021https://doaj.org/article/912b2c2cb46d40fe9cce81675290e46f2020-01-01T00:00:00Zhttps://www.dovepress.com/management-of-treatment-resistant-depression-challenges-and-strategies-peer-reviewed-article-NDThttps://doaj.org/toc/1178-2021Daphne Voineskos, 1, 2 Zafiris J Daskalakis, 1, 2 Daniel M Blumberger 1, 2 1Centre for Addiction and Mental Health, Toronto, Ontario, Canada; 2Department of Psychiatry, University of Toronto, Toronto, Ontario, CanadaCorrespondence: Daniel M BlumbergerCentre for Addiction and Mental Health, 1001 Queen Street West, Unit 4-1, Toronto, Ontario M6J1H4, CanadaTel +1 416 535-8501Fax +1 416 583-1358Email daniel.blumberger@camh.caAbstract: Treatment-resistant depression (TRD) is a subset of Major Depressive Disorder which does not respond to traditional and first-line therapeutic options. There are several definitions and staging models of TRD and a consensus for each has not yet been established. However, in common for each model is the inadequate response to at least 2 trials of antidepressant pharmacotherapy. In this review, a comprehensive analysis of existing literature regarding the challenges and management of TRD has been compiled. A PubMed search was performed to assemble meta-analyses, trials and reviews on the topic of TRD. First, we address the confounds in the definitions and staging models of TRD, and subsequently the difficulties inherent in assessing the illness. Pharmacological augmentation strategies including lithium, triiodothyronine and second-generation antipsychotics are reviewed, as is switching of antidepressant class. Somatic therapies, including several modalities of brain stimulation (electroconvulsive therapy, repetitive transcranial magnetic stimulation, magnetic seizure therapy and deep brain stimulation) are detailed, psychotherapeutic strategies and subsequently novel therapeutics including ketamine, psilocybin, anti-inflammatories and new directions are reviewed in this manuscript. Our review of the evidence suggests that further large-scale work is necessary to understand the appropriate treatment pathways for TRD and to prescribe effective therapeutic options for patients suffering from TRD.Keywords: treatment resistant depression, major depressive disorder, pharmacotherapy, psychotherapy, brain stimulation, novel therapiesVoineskos DDaskalakis ZJBlumberger DMDove Medical Pressarticlemajor depressive disordertreatment resistant depressionpharmacotherapybrain stimulationmood disordersNeurosciences. Biological psychiatry. NeuropsychiatryRC321-571Neurology. Diseases of the nervous systemRC346-429ENNeuropsychiatric Disease and Treatment, Vol Volume 16, Pp 221-234 (2020)
institution	DOAJ
collection	DOAJ
language	EN
topic	major depressive disorder treatment resistant depression pharmacotherapy brain stimulation mood disorders Neurosciences. Biological psychiatry. Neuropsychiatry RC321-571 Neurology. Diseases of the nervous system RC346-429
spellingShingle	major depressive disorder treatment resistant depression pharmacotherapy brain stimulation mood disorders Neurosciences. Biological psychiatry. Neuropsychiatry RC321-571 Neurology. Diseases of the nervous system RC346-429 Voineskos D Daskalakis ZJ Blumberger DM Management of Treatment-Resistant Depression: Challenges and Strategies
description	Daphne Voineskos, 1, 2 Zafiris J Daskalakis, 1, 2 Daniel M Blumberger 1, 2 1Centre for Addiction and Mental Health, Toronto, Ontario, Canada; 2Department of Psychiatry, University of Toronto, Toronto, Ontario, CanadaCorrespondence: Daniel M BlumbergerCentre for Addiction and Mental Health, 1001 Queen Street West, Unit 4-1, Toronto, Ontario M6J1H4, CanadaTel +1 416 535-8501Fax +1 416 583-1358Email daniel.blumberger@camh.caAbstract: Treatment-resistant depression (TRD) is a subset of Major Depressive Disorder which does not respond to traditional and first-line therapeutic options. There are several definitions and staging models of TRD and a consensus for each has not yet been established. However, in common for each model is the inadequate response to at least 2 trials of antidepressant pharmacotherapy. In this review, a comprehensive analysis of existing literature regarding the challenges and management of TRD has been compiled. A PubMed search was performed to assemble meta-analyses, trials and reviews on the topic of TRD. First, we address the confounds in the definitions and staging models of TRD, and subsequently the difficulties inherent in assessing the illness. Pharmacological augmentation strategies including lithium, triiodothyronine and second-generation antipsychotics are reviewed, as is switching of antidepressant class. Somatic therapies, including several modalities of brain stimulation (electroconvulsive therapy, repetitive transcranial magnetic stimulation, magnetic seizure therapy and deep brain stimulation) are detailed, psychotherapeutic strategies and subsequently novel therapeutics including ketamine, psilocybin, anti-inflammatories and new directions are reviewed in this manuscript. Our review of the evidence suggests that further large-scale work is necessary to understand the appropriate treatment pathways for TRD and to prescribe effective therapeutic options for patients suffering from TRD.Keywords: treatment resistant depression, major depressive disorder, pharmacotherapy, psychotherapy, brain stimulation, novel therapies
format	article
author	Voineskos D Daskalakis ZJ Blumberger DM
author_facet	Voineskos D Daskalakis ZJ Blumberger DM
author_sort	Voineskos D
title	Management of Treatment-Resistant Depression: Challenges and Strategies
title_short	Management of Treatment-Resistant Depression: Challenges and Strategies
title_full	Management of Treatment-Resistant Depression: Challenges and Strategies
title_fullStr	Management of Treatment-Resistant Depression: Challenges and Strategies
title_full_unstemmed	Management of Treatment-Resistant Depression: Challenges and Strategies
title_sort	management of treatment-resistant depression: challenges and strategies
publisher	Dove Medical Press
publishDate	2020
url	https://doaj.org/article/912b2c2cb46d40fe9cce81675290e46f
work_keys_str_mv	AT voineskosd managementoftreatmentresistantdepressionchallengesandstrategies AT daskalakiszj managementoftreatmentresistantdepressionchallengesandstrategies AT blumbergerdm managementoftreatmentresistantdepressionchallengesandstrategies
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Management of Treatment-Resistant Depression: Challenges and Strategies

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