Journal of Psychosocial Nursing and Mental Health Services

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Psychopharmacology 

Pharmacotherapy Strategies for Treatment-Resistant Depression

Robert H. Howland, MD

  • Journal of Psychosocial Nursing and Mental Health Services. 2006;44(11):11-14
  • Posted November 1, 2006

Abstract

EXCERPT

The goal of antidepressant drug therapy should be an optimal treatment outcome, which is the absence of significant depressive symptoms, along with a complete recovery of psychosocial function. This kind of outcome is referred to as full remission. With any first-choice antidepressant medication, only approximately 50% of patients will have a significant treatment response, usually defined as a 50% or greater decrease in depressive symptoms. Of those patients who respond to treatment, only approximately one half to one third attain full remission. Thus, a significant proportion of patients with depression are left with residual or persistent symptoms, despite apparently adequate antidepressant therapy (Trivedi et al., 2006a). Treatment-resistant depression (TRD) is therefore defined as the failure to achieve full remission with an antidepressant drug used at an adequate dosage for an adequate duration. In this article, I will discuss some fundamental pharmacotherapy strategies for TRD.

Abstract

EXCERPT

The goal of antidepressant drug therapy should be an optimal treatment outcome, which is the absence of significant depressive symptoms, along with a complete recovery of psychosocial function. This kind of outcome is referred to as full remission. With any first-choice antidepressant medication, only approximately 50% of patients will have a significant treatment response, usually defined as a 50% or greater decrease in depressive symptoms. Of those patients who respond to treatment, only approximately one half to one third attain full remission. Thus, a significant proportion of patients with depression are left with residual or persistent symptoms, despite apparently adequate antidepressant therapy (Trivedi et al., 2006a). Treatment-resistant depression (TRD) is therefore defined as the failure to achieve full remission with an antidepressant drug used at an adequate dosage for an adequate duration. In this article, I will discuss some fundamental pharmacotherapy strategies for TRD.

Authors
Dr. Howland is Associate Professor of Psychiatry, University of Pittsburgh School of Medicine, Western Psychiatric Institute and Clinic, Pittsburgh, Pennsylvania.

The author discloses that he has no significant financial interests in any product or class of products discussed directly or indirectly in this activity, including research support.

Address correspondence to Robert H. Howland, MD, Associate Professor of Psychiatry, University of Pittsburgh School of Medicine, Western Psychiatric Institute and Clinic, 3811 O’Hara Street, Pittsburgh, PA 15213; e-mail: HowlandRH@upmc.edu.

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