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by Professor Philip J.
Last updated: June 2017
Depressed patients referred to psychiatrists have nearly always
failed to respond to first-line treatment with antidepressant
medication. Subsequent care by the psychiatric team will involve a
comprehensive care package; however, for most patients
the adjustment of antidepressant medication will
also play an important role.
The use of medication in treatment-resistant
depression has benefited from the availability of an increasing
number of antidepressant drugs. However, the evidence base for
treating resistant depression is slight. Furthermore, it is
difficult to produce treatment algorithms that can be broadly
applicable; each patient must be treated as an individual and a
collaborative approach pursued.
The pharmacological approach to
treatment-resistant depression (TRD) is a vast subject area and one
that we could not possibly cover in depth here. The aim of
this module is to provide an overview of the subject. We start with
relatively simple interventions such as switching within and
between classes, and move on to treatment combinations with both
antidepressants and adjuncts such as lithium. The roles of
electroconvulsive therapy (ECT) and cognitive-behaviour therapy
(CBT) are also considered.
We hope that this module will help
general adult and old-age psychiatrists gain confidence in the
innovative use of pharmacological treatment in resistant
depression, and thereby help patients with this debilitating
condition to achieve better outcomes.
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