Treatment-resistant depression: Definitions, review of the evidence, and algorithmic approach

被引：307

作者：

McIntyre, Roger S. ^{[1
,2
,3
,4
]}

Filteau, Marie-Josee ^{[5
,6
,7
]}

Martin, Lawrence ^{[8
]}

Patry, Simon ^{[5
,9
]}

Carvalho, Andre ^{[2
,10
]}

Cha, Danielle S. ^{[1
,2
]}

Barakat, maxime ^{[11
]}

Miguelez, Maia ^{[11
]}

机构：

[1] Univ Toronto, Inst Med Sci, Toronto, ON, Canada

[2] Univ Hlth Network, Mood Disorders Psychopharmacol Unit, Toronto, ON M5T 2S8, Canada

[3] Univ Toronto, Dept Psychiat, Toronto, ON, Canada

[4] Univ Toronto, Dept Pharmacol, Toronto, ON, Canada

[5] Univ Laval, Dept Psychiat, Quebec City, PQ, Canada

[6] Univ Laval, Robert Giffard Res Ctr, Quebec City, PQ, Canada

[7] Clin Marie Fitzbach, Quebec City, PQ, Canada

[8] McMaster Univ, Dept Psychiat, Hamilton, ON, Canada

[9] Univ Montreal, Dept Psychiat, Montreal, PQ H3C 3J7, Canada

[10] Univ Fed Ceara, Psychiat Res Grp, Fac Med, Fortaleza, Ceara, Brazil

[11] Bristol Myers Squibb Canada, Montreal, PQ, Canada

来源：

JOURNAL OF AFFECTIVE DISORDERS | 2014年 / 156卷

关键词：

Major depressive disorder; Treatment-resistant depression (TRD); Atypical antipsychotics; Augmentation; Combination; Lithium; CANMAT CLINICAL GUIDELINES; SEROTONIN REUPTAKE INHIBITORS; RANDOMIZED CONTROLLED-TRIAL; PLACEBO-CONTROLLED TRIAL; DEEP BRAIN-STIMULATION; DOUBLE-BLIND; CANADIAN NETWORK; NEUROSTIMULATION THERAPIES; ANTIDEPRESSANT RESPONSE; MOOD DISORDERS;

D O I：

10.1016/j.jad.2013.10.043

中图分类号：

R74 [神经病学与精神病学];

学科分类号：

摘要：

Background: Most adults with major depressive disorder (MDD) fail to achieve remission with index pharmacological treatment. Moreover, at least half will not achieve and sustain remission following multiple pharmacological approaches. Herein, we succinctly review treatment modalities proven effective in treatment-resistant depression (TRD). Methods: We conducted a review of computerized databases (PubMed, Google Scholar) from 1980 to April 2013. Articles selected for review were based on author consensus, adequacy of sample size, the use of a standardized experimental procedure, validated assessment measures and overall manuscript quality. Results: The evidence base supporting augmentation of conventional antidepressants with atypical antipsychotics (i.e., aripiprazole, quetiapine, and olanzapine) is the most extensive and rigorous of all pharmacological approaches in TRD. Emerging evidence supports the use of some psychostimulants (i.e., lisdexamfetamine) as well as aerobic exercise. In addition, treatments informed by pathogenetic disease models provide preliminary evidence for the efficacy of immune-inflammatory based therapies and metabolic interventions. Manual based psychotherapies remain a treatment option, with the most compelling evidence for cognitive behavioral therapy. Disparate neurostimulation strategies are also available for individuals insufficiently responsive to pharmacotherapy and/or psychosocial interventions. Limitations: Compared to non-treatment-resistant depression, TRD has been less studied. Most clinical studies on TRD have focused on pharmacotherapy-resistant depression, with relatively fewer studies evaluating "next choice" treatments in individuals who do not initially respond to psychosocial and/or neurostimulatory treatments. Conclusion: The pathoetiological heterogeneity of MDD/TRD invites the need for mechanistically dissimilar, and empirically validated, treatment approaches for TRD. (C) 2013 Elsevier By. All rights reserved.

引用

页码：1 / 7

页数：7

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