Treatment Resistant Depression

This book Is comprehensive, addressing treatment options, including psychopharmacotherapy, psychotherapy, neuromodulation (ECT, transcranial magnetic stimulation, deep brain stimulation, vagus nerve stimulation), exercise, nutrition, self ...

Treatment Resistant Depression

Author: University of Michigan Comprehensive Depression Center

Publisher: American Psychiatric Pub

ISBN: 1585629537

Page: 364

View: 719

As many as 35-40% of patients afflicted with Major Depressive Disorder (MDD) are treatment resistant, a situation that places a massive emotional and financial burden on society and challenges the mental health profession to develop new treatment paradigms and practices. Even the most astute clinicians can be frustrated when treatment options fail to be effective or work for only a brief time, leaving them to wonder what course to pursue next. Treatment Resistant Depression: A Roadmap for Effective Care gives clinicians and their patients what they need most desperately: a sequence of steps that reflect state-of-the-art diagnostic procedures and integrates all evidence-based treatment modalities -- in short, a roadmap to wellness and recovery. Based primarily on the experiences of the authors, all of whom are leading researchers and/or clinicians in Treatment Resistant Depression and affiliated with the University of Michigan Comprehensive Depression Center, the book also draws upon the clinical research advances and treatment innovations of programs around the world. Although the book's step-by-step organization is clear and easy to follow, its coverage, scope, and level of sophistication are anything but simplified. This book Is comprehensive, addressing treatment options, including psychopharmacotherapy, psychotherapy, neuromodulation (ECT, transcranial magnetic stimulation, deep brain stimulation, vagus nerve stimulation), exercise, nutrition, self-management approaches to enhance adherence, behavioral sleep programs, and others Addresses treatment resistant depression across the lifespan, reflecting the diverse demographics of depression, which knows no age, gender, or socioeconomic status Emphasizes the authors' commitment to early intervention and provides techniques for identifying young people who are at risk for developing depression or already expressing symptoms of the disease Recognizes the chronicity of depression, rather than focusing on only the acute stage, and in this way allows for more effective treatment over the patient's lifetime Introduces self-management as playing a critical role in the patient's prognosis, engagement, adherence to clinical steps that help maintain recovery, and self-esteem Promotes the development of new, personalized, and predictive biomarkers to target treatment more effectively. Designed to be useful across disciplines and treatment modalities, the book includes a multitude of tables, graphs, and learning aids that will benefit students, instructors, and clinicians. At the same time, the book promises to be a valuable resource for patients and their families, since Treatment Resistant Depression is both difficult to live with and little understood. No other book offers so much practical guidance, sound research and hope.

Treatment Resistant Depression

This book clearly and succinctly summarizes the latest scientific research and its applications in clinical practice.

Treatment Resistant Depression

Author: Siegfried Kasper

Publisher: John Wiley & Sons

ISBN: 1118556739

Page: 232

View: 927

The first book devoted to a challenging disorder that affectsmillions of people around the world. Essential reading forall psychiatrists who manage these patients.

Ketamine for Treatment Resistant Depression

Ketamine for Treatment-Resistant Depression: Neurobiology and Applications provides a simple, evidence-based overview for neuropsychiatrists and translational researchers on this medication, its mechanisms of actions, eligibility of ...

Ketamine for Treatment Resistant Depression

Author: Gustavo H. Vazquez

Publisher: Academic Press

ISBN: 0128210338

Page: 150

View: 364

Ketamine for Treatment-Resistant Depression: Neurobiology and Applications provides a simple, evidence-based overview for neuropsychiatrists and translational researchers on this medication, its mechanisms of actions, eligibility of patients for treatment, and the preparation and implementation of ketamine clinics. Provides efficacy research on ketamine as a treatment for depression Identifies best practices for clinical use, both long-term and acute Discusses the molecular mechanisms and neurobiology of action

Pharmacotherapy for Depression and Treatment resistant Depression

1. Major depressive disorder and treatment-resistant depression. 1.1.

Pharmacotherapy for Depression and Treatment resistant Depression

Author: George I. Papakostas

Publisher: World Scientific

ISBN: 9814287598

Page: 699

View: 211

This unique ground-breaking work, authored by renowned Harvard-based researchers G I Papakostas and M Fava, represents, by far, the most comprehensive compilation to date of medical studies and reports involving the use of anti-depressants for the treatment of major depressive disorder, one of the most prevalent and devastating medical illnesses afflicting mankind today. Given the breadth of the scientific literature focusing on the use of anti-depressants for major depressive disorder, this work represents an invaluable tool for clinicians as well as scientists in search of a reference manual to help guide them through the field. The book is organized into four parts; each part focusing on a separate theme that will facilitate the reader to precisely access particular information of interest, whether be it clinical or scientific in nature. Each part is then sub-divided into several thematic chapters, which are enriched with tables and figures citing results from the most influential studies in the field. Finally, clinical and research pearls are listed throughout the book in bullet-point fashion to help summarize the available knowledge-base in a user-friendly format.

Ketamine for Treatment Resistant Depression

This book brings together an international group of clinicians and researchers from a broad swath of inter-related disciplines to offer the most up-to-date information about clinical and preclinical research into ketamine and second ...

Ketamine for Treatment Resistant Depression

Author: Sanjay J. Mathew

Publisher: Springer

ISBN: 3319429256

Page: 155

View: 417

This book brings together an international group of clinicians and researchers from a broad swath of inter-related disciplines to offer the most up-to-date information about clinical and preclinical research into ketamine and second-generation “ketamine-like” fast-acting antidepressants. Currently available antidepressant medications act through monoaminergic systems, are ineffective for many individuals suffering from depression, and are associated with a delayed onset of peak efficacy of several months. The unexpected emergence of ketamine, an anesthetic N-methyl-D-aspartate (NMDA) receptor antagonist, as a rapid-acting antidepressant has reinvigorated CNS drug discovery research and catalyzed investigation in patient populations historically ignored in antidepressant drug development programs, particularly treatment-resistant patients and those with suicidality. Recent industry and academic research efforts have coalesced to explore NMDA receptor and glutamatergic molecular targets that lack ketamine’s psychotomimetic side effects and abuse liability but retain its rapid onset of efficacy. However, many fundamental questions remain regarding the neurobiological mechanisms underlying ketamine’s rapid antidepressant effects and the puzzling persistence of benefits observed in some patients following a single dose. This book examines how insights from these studies are forging new conceptual models of the neurobiology of stress-related affective, anxiety, and addictive disorders and the nature of treatment resistance. It also discusses how ketamine’s rapid antidepressant effects provide a scientific platform to facilitate innovation in clinical trial designs pertaining to patient selection, choice of control group, outcome measures, and dose-optimization. This book brings together data and insights from this rapidly expanding and extraordinarily promising field of study. Readers will be able to extract integrated themes and useful insights from the material contained in these diverse chapters and appreciate the paradigm-shifting contributions of ketamine to modern psychiatry and clinical neuroscience research.

Evidence Synthesis for Determining the Efficacy of Psychotherapy for Treatment Resistant Depression

The current review will address the effectiveness of psychotherapeutic approaches as a second step treatment for MDD in patients who do not achieve remission after initial treatment with antidepressants.

Evidence Synthesis for Determining the Efficacy of Psychotherapy for Treatment Resistant Depression

Author: U. S. Department of Veterans Affairs

Publisher: Createspace Independent Pub

ISBN: 9781490304182

Page: 42

View: 244

Major depressive disorder (MDD) is one of the leading causes of disability worldwide. The lifetime prevalence of MDD in the general population is estimated at 13%2, of which approximately 20% will experience chronic depression and 60-85% will experience recurrence and relapse. This number is even higher in the VA medical system, where an estimated one third of veterans experience MDD. MDD is associated with greater health care utilization, greater functional impairment, and increased mortality. In addition, subclinical symptoms of depression can reduce quality of life, worsen disability, and adversely affect co-existing chronic medical conditions. Both antidepressant medications and depression-specific psychotherapies are effective as first-line treatments for MDD. In primary care settings, most patients with MDD are treated with antidepressant medications, but a substantial proportion of patients fail to recover with this initial treatment. This evidence synthesis was requested to evaluate the efficacy of psychological treatments as step-2 treatment for patients with MDD who do not achieve remission with an initial course of antidepressant medication. Major depressive disorder (MDD) is a prevalent disorder impacting an estimated 13% of the general population, and a third of the veteran population. Of the patients who experience at least one depressive episode, approximately 20% will experience chronic depression and 60-85% will experience recurrence and relapse. Antidepressant medications are the most commonly prescribed treatment modality for MDD and are often the first line of treatment in primary care settings. However, fewer than 50% of patients fully remit after adequate dosage of antidepressant treatment. Treatment options for these “treatment resistant” patients vary but typically involve using other psychoactive medications as augmentation (i.e., addition of another medication) or substitution treatment (i.e., switching medications). Less attention has been paid to using psychotherapy as an augmentation or substitution treatment for treatment resistant patients, despite psychotherapy being associated with clinical improvements in MDD comparable to those achieved with antidepressants. The current review will address the effectiveness of psychotherapeutic approaches as a second step treatment for MDD in patients who do not achieve remission after initial treatment with antidepressants. Question: In primary care patients with major depressive disorder who do not achieve remission with acute phase antidepressant treatment, is empirically based psychotherapy used as an augmentation or substitution treatment more effective than control for achieving remission?

Treatment resistant Depression Trd

This book provides new research on treatment options, challenges and the future directions for individuals with TRD.

Treatment resistant Depression Trd

Author: Deborah Diaz

Publisher:

ISBN: 9781536108255

Page: 100

View: 856

Major Depressive Disorder (MDD) is a common and debilitating neuropsychiatric disorder with high economic and societal impact. Approximately 30% of subjects with MDD achieve full remission after treatment with conventional antidepressants resulting in a relevant percentage of patients suffering from treatment resistant depression (TRD). Treating TRD is a difficult challenge for psychiatrists due to the complexity of this disabling condition. In fact, TRD is generally associated with a poorer outcome, higher suicidal risk, more severe psychosocial impairment and physical disability when compared to MDD. This book provides new research on treatment options, challenges and the future directions for individuals with TRD.

Evidence Synthesis for Determining the Efficacy of Psychotherapy for Treatment Resistant Depression

The current review will address the effectiveness of psychotherapeutic approaches as a second step treatment for MDD in patients who do not achieve remission after initial treatment with antidepressants.

Evidence Synthesis for Determining the Efficacy of Psychotherapy for Treatment Resistant Depression

Author: Ranak Trivedi

Publisher:

ISBN:

Page: 35

View: 905

BACKGROUND: Major depressive disorder (MDD) is a prevalent disorder impacting an estimated 13% of the general population, and a third of the veteran population. Of the patients who experience at least one depressive episode, approximately 20% will experience chronic depression and 60-85% will experience recurrence and relapse. Antidepressant medications are the most commonly prescribed treatment modality for MDD and are often the first line of treatment in primary care settings. However, fewer than 50% of patients fully remit after adequate dosage of antidepressant treatment. Treatment options for these "treatment resistant" patients vary but typically involve using other psychoactive medications as augmentation (i.e., addition of another medication) or substitution treatment (i.e., switching medications). Less attention has been paid to using psychotherapy as an augmentation or substitution treatment for treatment resistant patients, despite psychotherapy being associated with clinical improvements in MDD comparable to those achieved with antidepressants. The current review will address the effectiveness of psychotherapeutic approaches as a second step treatment for MDD in patients who do not achieve remission after initial treatment with antidepressants. Question: In primary care patients with major depressive disorder who do not achieve remission with acute phase antidepressant treatment, is empirically based psychotherapy used as an augmentation or substitution treatment more effective than control for achieving remission? SUMMARY: In summary, two good quality, moderate-sized trials showed equal benefit from augmenting antidepressant medication with CT and from active medication management, one fair quality small study showed lithium augmentation to be more beneficial than CT, and one fair quality trial showed short-term benefit from augmentation through 16 sessions of DBT. A moderate-sized, good quality study and a small, poor quality study found equal benefit from substituting CT for antidepressant treatment and from continuing management of depression with medication. There was significant heterogeneity in study designs, sample sizes, and comparator groups, and most studies were underpowered to detect moderate effect sizes. We conclude that current trials do not support favoring psychotherapy over antidepressant medication for mid-life adults with treatment resistant MDD; however, psychotherapy appears to be an equally effective treatment compared to antidepressant medication and is therefore a reasonable treatment option for this demographic. Whether these results are directly applicable to Veterans is uncertain because most study samples were mid-life adults, more than 50% female, and medical and psychiatric co-morbidity was incompletely described. The limited number of studies, mixed effects and uncertain applicability to Veterans suggest a need for additional trials to adequately evaluate the potential treatment benefit of psychotherapy for treatment resistant depression.

Treatment resistant Mood Disorders

Providing a concise view of the current definitions, assessment and evidence-based management of such disorders, this work reviews novel therapeutic targets, which may enhance the future therapeutic armamentarium of clinicians.

Treatment resistant Mood Disorders

Author: Andre Carvalho

Publisher: Oxford University Press, USA

ISBN: 0198707991

Page: 160

View: 146

Treatment-resistant major depression and bipolar disorder are highly prevalent and disabling conditions associated with substantial morbidity and mortality. The assessment and management of refractory patients with mood disorders is a major clinical challenge for mental health providers. Part of the Oxford Psychiatry Library (OPL) series, this pocketbook provides a concise view of the current definitions, assessment and evidence-based management of treatment-resistant mood disorders and reviews novel therapeutic targets for mood disorders, which may enhance the therapeutic armamentarium of clinicians in the near future. The pocketbook serves as a useful guide for mental health practitioners, including psychiatrists, clinical psychologists, trainees, and interested primary care physicians.

Management of Treatment Resistant Major Psychiatric Disorders

This book summarizes the latest evidence from clinical studies concerning the treatment of patients with treatment-resistant psychiatric disorders.

Management of Treatment Resistant Major Psychiatric Disorders

Author: Charles B. Nemeroff

Publisher: OUP USA

ISBN: 0199739986

Page: 366

View: 740

A sizable percentage of patients with major psychiatric disorders do not respond to the first or second treatments they receive. This book summarizes the latest evidence from clinical studies concerning the treatment of patients with treatment-resistant psychiatric disorders. Both pharmacological and psychotherapeutic interventions are included, as well as somatic non-pharmacological treatments. The chapter authors represent the leaders in their respective fields.

Ketamine for Treatment Resistant Depression

Ketamine for Treatment-Resistant Depression: Neurobiology and Applications provides a simple, evidence-based overview for neuropsychiatrists and translational researchers on this medication, its mechanisms of actions, eligibility of ...

Ketamine for Treatment Resistant Depression

Author: Gustavo H. Vazquez

Publisher: Academic Press

ISBN: 0128210346

Page: 168

View: 680

Ketamine for Treatment-Resistant Depression: Neurobiology and Applications provides a simple, evidence-based overview for neuropsychiatrists and translational researchers on this medication, its mechanisms of actions, eligibility of patients for treatment, and the preparation and implementation of ketamine clinics. Provides efficacy research on ketamine as a treatment for depression Identifies best practices for clinical use, both long-term and acute Discusses the molecular mechanisms and neurobiology of action

Ready Set Action Potential Breakthrough Therapy for Treatment Resistant Depression

Major depressive disorder is a psychiatric illness that is associated with a variety of debilitating symptoms such as persistent sadness, lack of interest and motivation, lassitude, pessimistic thoughts, and in severe cases, suicidal ...

Ready  Set  Action  Potential Breakthrough Therapy for Treatment Resistant Depression

Author: Alvin Garlejo

Publisher:

ISBN:

Page:

View: 166

Major depressive disorder is a psychiatric illness that is associated with a variety of debilitating symptoms such as persistent sadness, lack of interest and motivation, lassitude, pessimistic thoughts, and in severe cases, suicidal ideation and behavior. Current psychological and pharmacological treatments have been demonstrated efficacious; however, an ever-growing number of individuals frequently report minimal to no improvement with these treatments; and in some cases, a worsening of symptoms. This inadequacy to treatment is commonly known as treatment-resistant depression. At Kadima Neuropsychiatry Institute, Dr. Feifel treats individuals with treatment-resistant depression with advanced treatments such as TMS and ketamine. During my fieldwork internship at Kadima Neuropsychiatry Institute, my project focused on evaluating the efficacy of ketamine administered intramuscular to patients with treatment-resistant depression and determining which characteristics of a patient0́9s psychedelic experience or 0́−trip0́+ is associated with the decrease in their depressive symptoms. The results of this project demonstrated that an initial low dose of ketamine was significantly quick and efficacious in decreasing depressive symptoms in patients with treatment resistant depressive. In addition, a first of its kind exploratory analysis suggested that the intensity, positive content, and dissociative characteristics of a ketamine induced psychedelic trip were strongly associated with the decrease in depressive symptoms. Despite the significance in these results, more research needs to include a larger sample and explore the specific subjective characteristics within a psychedelic 0́−trip0́+ to further understand its association with a decrease in depressive symptoms. The quick and efficacious antidepressant effects of ketamine demonstrated in this project provide much potential for a program involving a mobile ketamine clinic to address severe depression and suicidality. Such therapeutic and intervention potentials can be explored further given an expansion of current policy limiting ketamine as a schedule III substance.

05 KETAMINE ANTIDEPRESSANT ACTIONS IN ELECTROCONVULSIVE THERAPY OF TREATMENT RESISTANT DEPRESSION

Background and aims: Major depressive disorder affects approximately 5% of the population with nearly 1-third of patients failing to achieve remission, despite adequate pharmacological treatment [1].

05   KETAMINE ANTIDEPRESSANT ACTIONS IN ELECTROCONVULSIVE THERAPY OF TREATMENT RESISTANT DEPRESSION

Author: Bruno Josu00e9 Prates

Publisher:

ISBN:

Page:

View: 846

Background and aims: Major depressive disorder affects approximately 5% of the population with nearly 1-third of patients failing to achieve remission, despite adequate pharmacological treatment [1]. Although electroconvulsive therapy (ECT) is the gold standard approach for treatment resistant depression (TRD), a considerable fraction of patients also show a delayed improvement or appear to be resistant to ECT. One of the most promising rapid-acting antidepressants is ketamine, a noncompetitive N-methyl-D-Aspartate receptor antagonist that can be used as an anesthetic during ECT to augment antidepressant efficacy [2].Data on ECTs using ketamine are both scarce and conflicting which lead the American Psychiatric Association to call for further studies [3]. We aim to clarify the potential synergism of ketamine and ECT for the treatment of TRD.Materials and methods: An experimental, non-randomized clinical trial with consecutive sampling of TRD patients with a HAM-D and PDAS scores u2265 23 was conducted. Patients that were initially assigned to 6 ECT sessions using thiopental anesthesia (ECT Std) but showed a very limited symptomatic relief were included in the study. Patients in Group 1 were then treated with further 6 ECT sessions using ketamine anesthesia (ECT Ket) whereas Group 2 maintained treatment with ECT Std (Fig. 1).Results: Clinical assessment showed no significant reduction in the mean HAM-D and PDAS scores for Group 1 but a significant reduction of the HAMD score of 38,8u00b12,4 to 13.4u00b110.55 (p

Understanding Treatment resistant Depression

Background: Treatment-resistant depression (TRD) encompasses a segment of individuals with major depressive disorder who are severely ill in terms of chronicity, comorbidity, and prognosis.

Understanding Treatment resistant Depression

Author: Maya Gupta

Publisher:

ISBN:

Page: 120

View: 169

Background: Treatment-resistant depression (TRD) encompasses a segment of individuals with major depressive disorder who are severely ill in terms of chronicity, comorbidity, and prognosis. Although functional impairment is a prominent and costly feature of treatment-resistance, very little is known about the factors that contribute to and maintain functional impairment in TRD. Purpose: This study examined the relationships among neurocognition, symptoms, and functional impairment in TRD. Specifically, I examined the neurocognitive impairments that relate to different symptom domains and to level of symptom severity, as well as the predictors of functional outcomes and real-world behaviour in TRD. Method: Patients (N = 29) with a diagnosis of major depressive disorder were recruited from the Mood Disorders Treatment and Research Service at Providence Care Mental Health Services in Kingston, Ontario. Data were collected during a baseline assessment for a neurocognitive enhancement therapy program. Results: Individuals with TRD show mild to moderate impairments across all neurocognitive domains, with a superimposed severe impairment in verbal working memory. Verbal working memory significantly correlated with depressive symptoms and anxiety, such that increased verbal working memory capacity was related to more severe clinical symptoms. Greater response inhibition significantly correlated with less anxiety. Interpersonal competence was predicted by sustained attention and severity of depressive symptoms. Adaptive competence was significantly predicted by age at baseline and set shifting. Real-world work behaviour, interpersonal relations, and general satisfaction were predicted by the severity of depressive symptoms, whereas observed mood and anxiety predicted real-world recreational activity. Conclusions: The current study pioneered some of the first data regarding the relationships among neurocognition, symptoms, and functional outcomes in treatment-resistant depression. Verbal working memory appears to play an important role in the symptomatology of TRD. Neurocognitive variables and depressive symptoms are important in predicting functional competence (what one can do) but only depressive symptoms predict functional performance (what one actually does in the real world). There may be additional intrinsic or extrinsic factors that mediate the relationships among neurocognition, symptoms, and functioning in TRD.

11 THE USE OF SUBCUTANEOUS KETAMINE FOR TREATMENT RESISTANT DEPRESSION

Introduction: Major depressive disorder is highly common with up to 50% to 60% of the patients not achieving adequate response following antidepressant treatment.

11   THE USE OF SUBCUTANEOUS KETAMINE FOR TREATMENT RESISTANT DEPRESSION

Author: Mariane Quieroti Rodrigues

Publisher:

ISBN:

Page:

View: 311

Introduction: Major depressive disorder is highly common with up to 50% to 60% of the patients not achieving adequate response following antidepressant treatment. In this scenario, ketamine emerges as an important alternative to conventional treatments, with its action of being an antagonist of N-methyl- D-aspartate (NMDA) receptor, once its has a quick and effective action. Ketamine is most frequently administered intravenous. However, oral, sublingual, transmucosal, intranasal, subcutaneous (SC), and intramuscular routes of administration have also been examined.Aim: This study aims to investigate whether SC ketamine is effective in the treatment of unipolar major depression and if it has more effective and sustainable response than electroconvulsivetherapy (ECT).Methods: Participants will be comprised of patients with unipolar depression resistant to conventional treatment, men and women, aged u2265 18 across a range of ethnicities, recruited from General Hospital Servidor of State of Su00e3o Paulo, Brazil. Participants will be separeted in two groups. The first one will recieve a SC administration of ketamine in the dose of 0,5mg/kg weekly, for 6 weeks. The second will be submitted to ECT treatment, two sessions a week, for at least 8 sessions. The response of each treatment will be evaluated and compared by MADRS questionnaire.Results: We expect that SC ketamine has a good response in the treatment of major depression and that it has a similar response compared to ECT.Conclusion: SC ketamine, once it is a secure, quick and simple procedure, is a promising alternative to the available treatments.

Still Down

In Still Down, Dr. MacKinnon uses case studies of such individuals to reassess treatment-resistant depression (TRD) and explore what's going on with people who don't feel better, even with treatment.

Still Down

Author: Dean F. MacKinnon

Publisher: JHU Press

ISBN: 1421421062

Page: 152

View: 210

"Many people have depression symptoms that resist treatment. Despite medications, psychotherapy, and sometimes electroconvulsive therapy, these people don't feel well. What can they do to feel better? Dr. Dean MacKinnon, a psychiatrist at Johns Hopkins Hospital in Baltimore, specializes in finding out why treatment hasn't been helpful for a patient, and in helping that patient feel better. In Still Down, Dr. MacKinnon uses case studies of such individuals to reassess treatment-resistant depression (TRD) and explore what's going on with people who don't feel better, even with treatment. As some of the cases illustrate, some people who have been diagnosed with treatment-resistant depression have depression that actually will respond to appropriate treatment--but they have not yet received appropriate treatment. Other cases illustrate what happens when someone is incorrectly diagnosed with depression; that person needs treatment for a different disorder, not for depression. Finally, some cases illustrate people who have depression that does not respond to treatment for depression, regardless of how finely tuned the treatment is. These people, who have true TRD, can benefit from a variety of treatments alone or in combination, and even though they may not feel entirely well, they can feel better. Writing for people who have treatment-resistant depression and their families, as well as medical professionals and mental health care providers, MacKinnon hopes to help people with depression get appropriate diagnoses and treatment. He also hopes to improve care providers' understanding of treatment-resistant depression, by identifying aspects of the individual's qualities, behaviors, and experiences that may account for poor response to treatment"--