Pharmacological treatment of resistant depression: an overview

by Professor Philip J. Cowen

 

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.

 

Start the module

 

 

If you like this module, you may also be interested in:

 

Antidepressants and psychosexual dysfunction: Part 1 diagnosis by Dr Ursula Werneke

 

Pharmacological management of anxiety disorders by Dr Zia Nadeem and Dr Allan Scott

 

Pharmacological management of mania by Dr Karine A.N. Macritchie and Professor Allan H. Young

 

Polypharmacy: causes and consequences by Dr V R Badrakalimuthu

 

Treating depression in later life by Professor Robert Baldwin, Dr Deepak K Sachdeva and Dr Amit Nulkar

 

 

BJPsych Advances: related articles for CPD Online

 

 

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