Treatment Resistant Depression: Strategies for Primary Care

  • Taylor C. Preston
  • Richard C. SheltonEmail author
Psychiatry in Primary Care (BN Gaynes, Section Editor)
Part of the following topical collections:
  1. Topical Collection on Psychiatry in Primary Care


Depression is commonly diagnosed and treated in primary care. Recent evidence indicates that the majority of depressed patients will not fully recover with an initial antidepressant treatment. This paper reviews commonly used options for treatment after an inadequate initial antidepressant response. The alternatives range widely, and include escalating the dose of the initial antidepressant, switching to an alternative medication, combining two antidepressants with different mechanisms of action (e.g., bupropion + SSRI or mirtazapine + venlafaxine), adding other medications such as lithium or certain atypical antipsychotics (olanzapine, aripiprazole, or quetiapine) to the antidepressant, adding a natural product such as l-methylfolate or s-adenosylmethionine (SAMe), or adding cognitive behavioral psychotherapy. What agent to be used will depend on the comfort level of the primary care practitioner and the availability of Psychiatry referral. However, it is reasonable to take one or more additional steps to attempt to achieve remission.


Depression Antidepressants Treatment-resistant depression Augmentation Combination therapy Antidepressant switch Complementary and alternative therapy Psychotherapy Psychiatry Primary care 


Conflict of Interest

Taylor C. Preston declares that he has no conflict of interest.

Richard C. Shelton has served as a consultant to the following: Bristol-Myers Squibb, Cyberonics, Inc., Elan, Corp., Eli Lilly and Company, Euthymics Bioscience, Forest Pharmaceuticals, Janssen Pharmaceutica, Medtronic, Inc., Otsuka Pharmaceuticals, Pamlab, Inc., Pfizer, Inc., Ridge Diagnostics, Takeda Pharmaceuticals.

Dr. Shelton has received research grant support from the following: Appian Labs, Bristol-Myers Squibb, Elan, Corp., Eli Lilly and Company, Euthymics Bioscience, Forest Pharmaceuticals, Janssen Pharmaceutica, Naurex, Inc., Novartis Pharmaceuticals, Otsuka Pharmaceuticals, Pamlab, Inc., Repligen, Corp., Ridge Diagnostics, St. Jude Medical, Inc., Takeda Pharmaceuticals.


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Copyright information

© Springer Science+Business Media New York 2013

Authors and Affiliations

  1. 1.Department of Psychiatry and Behavioral NeurobiologyThe University of Alabama at BirminghamBirminghamUSA

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