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Combination Strategies in Treatment-Resistant Depression

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Melatonin, Neuroprotective Agents and Antidepressant Therapy

Abstract

Treatment-resistant depression (TRD) is a serious public health problem: high prevalence (40–50 % of outpatient depression patients fail to respond satisfactorily to treatment with antidepressants in monotherapy, with the correct dose, regime and duration); social significance (high medical cost); individual suffering it causes (poor prognosis, chronicity, increased risk of suicide). The combination strategy is an option being used more and more frequently at the clinical level, and tends to be effective in 50–60 % of cases, though this varies according to the drug employed. This review analyze the state of the evidence on this therapeutic strategy, focusing on the family of antidepressants known as selective noradrenaline reuptake inhibitors (NARIs), particularly reboxetine, one of the antidepressants most widely used in combination therapy for TRD in recent years. The results obtained in combination strategies with reboxetine–especially in conjunction with SSRIs–suggest that it is a potentially useful tool.

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Authors and Affiliations

  1. Faculty of Health Sciences, Camilo José Cela University, Villanueva de la Cañada, Madrid, Spain

    Francisco López-Muñoz

  2. Neuropsychopharmacology Unit, Hospital 12 de Octubre Research Institute (i+12), Madrid, Spain

    Francisco López-Muñoz

  3. Portucalense Institute of Neuropsychology and Cognitive and Behavioural Neurosciences, Portucalense University, Porto, Portugal

    Francisco López-Muñoz

  4. Department of Biomedical Sciences (Pharmacology Area), Faculty of Medicine and Health Sciences, University of Alcalá, Madrid, Spain

    Cecilio Álamo & Pilar García-García

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  1. Francisco López-Muñoz
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  2. Cecilio Álamo
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  3. Pilar García-García
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Correspondence to Francisco López-Muñoz .

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  1. Vice-Rectorate for Research and Sci, Camilo José Cela University Vice-Rectorate for Research and Sci, Madrid, Spain

    Francisco López-Muñoz

  2. International Medical Sciences Research Study Center, Sri Sathya Sai Medical Educational & Research Foundation, Coimbatore, India

    Venkataramanujam Srinivasan

  3. Department of Neurosciences and Ima, University of Chieti Department of Neurosciences and Ima, Italy, Italy

    Domenico de Berardis

  4. Department of Biomedical Sciences (Pharmacology Area), University of Alcalá, Madrid, Spain

    Cecilio Álamo

  5. Department of Neuropsychiatry, Kyushu University, Fukuoka, Japan

    Takahiro A. Kato

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López-Muñoz, F., Álamo, C., García-García, P. (2016). Combination Strategies in Treatment-Resistant Depression. In: López-Muñoz, F., Srinivasan, V., de Berardis, D., Álamo, C., Kato, T. (eds) Melatonin, Neuroprotective Agents and Antidepressant Therapy. Springer, New Delhi. https://doi.org/10.1007/978-81-322-2803-5_28

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