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Pharmacological Management of Treatment-Resistant Depression

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Psychopharmacology: Current Trends

Part of the book series: Psychopharmacology Series ((PSYCHOPHARM,volume 5))

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Abstract

Treatment-resistant depression might be considered as the failure of two families of antidepressant therapy given sequentially at sufficient dosage, for an adequate length of time and with continuous compliance. Patients with treatment-resistant depression should be assessed as though they were new referrals, and factors which may be contributing should be dealt with whenever possible. A sequence of therapies based on a tricyclic antidepressant and a monoamine oxidase inhibitor, each combined with putative adjuvant therapies, is proposed as a working model pending further studies and developments.

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References

  • Akiskal HS (1985) A proposed clinical approach to chronic and “resistant” depressions: evaluation and management. J Clin Psychiatry 46: 32–36

    PubMed  CAS  Google Scholar 

  • Baldwin RC, Jolley DJ 81986) The prognosis of depression in old age. Br J Psychiatry 149: 574–583

    Google Scholar 

  • Barker WA, Eccleston D (1984) The treatment of chronic depression: an illustrative case. Br J Psychiatry 147: 317–319

    Article  Google Scholar 

  • Chouinard G, Young SN, Annable L, Sourkes TL (1979) Tryptophan-nicotinamide, imipramine and their combination in depression: a controlled study. Acta Psychiatr Scand 59: 395–414

    Article  PubMed  CAS  Google Scholar 

  • Coppen A, Shaw DM, Farrell JP (1963) Potentiation of the antidepressive effects of a monoamine oxidase inhibitor by tryptophan. Lancet 1: 79–81

    Article  PubMed  CAS  Google Scholar 

  • DeMontigny C, Grunberg F, Mayer A, Deschenes J-P (1981) Lithium induced rapid relief of depression in tricyclic and antidepressant drug non-responders. Br J Psychiatry 138: 252–256

    Article  CAS  Google Scholar 

  • DeMontigny C, Cournoyer G, Morissette R, Langlois R, Caille G (1983) Lithium carbonate addition in tricyclic antidepressant-resistant unpolar depression. Arch Gen Psychiatry 40: 1327–1334

    Article  CAS  Google Scholar 

  • DeMontigny C, Elie R, Caille G (1985) Rapid response to the addition of lithium in iprindole-resistant unipolar depression: a pilot study. Am J Psychiatry 142: 220–223

    CAS  Google Scholar 

  • Drimmer EJ, Gitlin MJ, Gwirtsman HE (1983) Desimipramine and methylphenidate combination treatment for depression. Am J Psychiatry 140: 241–242

    PubMed  CAS  Google Scholar 

  • Earle BV (1970) Thyroid hormone and tricyclic antidepressants in resistant depressions. Am J Psychiatry 126: 1667–1669

    PubMed  CAS  Google Scholar 

  • Eccleston D (1984) Evaluation and treatment of chronic depressive illness. Hosp Update 10: 517–523

    Google Scholar 

  • Garbutt JC, Mayo JP, Gillette GM, Little KY, Mason GA (1986) Lithium potentiation of tricyclic antidepressants following lack of T3 potentiation. Am J Psychiatr 143: 1038–1039

    PubMed  CAS  Google Scholar 

  • Gerner RH (1984) Antidepressant selection in the elderly. Psychosomatics 25 (7): 528–535

    Article  PubMed  CAS  Google Scholar 

  • Glassman AH, Platman SR (1969) Potentiation of a monoamine oxidase inhibitor by tryptophan. J Psychiatr Res 7: 83–88

    Article  PubMed  CAS  Google Scholar 

  • Goff DC, Jenike MA (1986) Treatment-resistant depression in the elderly. J Am Geriatr Soc 34: 63–70

    PubMed  CAS  Google Scholar 

  • Goodwin FK, Prange AJ, Post RM, Muscettola GE, Lipton MA (1982) Potentiation of antidepressant effects by 1-triiodothyronine in tricyclic non-responders. Am J Psychiatr 139: 34–38

    PubMed  CAS  Google Scholar 

  • Haskovec L (1967) The action of reserpine on imipramine-resistant depressive patients: clinical and biochemical study. Psychopharmacologie (Berlin) 11: 18–30

    Article  CAS  Google Scholar 

  • Heninger GR, Charney DS, Sternberg DE (1983) Lithium carbonate augmentation of antidepressant treatment. Arch Gen Psychiatry 40: 1335–1342

    Article  PubMed  CAS  Google Scholar 

  • Himmelhoch JM, Petre T, Kupfer JD, Swartzburg MD, Byck R (1972) Treatment of previously intractible depressions with tranylcypromine and lithium. J Nerv Ment Dis 155: 216–220

    Article  PubMed  CAS  Google Scholar 

  • Hopkinson G, Kenny F (1975) Treatment with reserpine of patients resistant to tricyclic antidepressants. Psychiatr Clin (Basel) 8: 109–114

    CAS  Google Scholar 

  • Katon W, Raskin M (1980) Treatment of depression in the medically ill elderly with methylphenidate. Am J Psychiatry 137: 963–965

    PubMed  CAS  Google Scholar 

  • Kaufmann MW, Cassem NH, Murray GB et al. (1984) Use of psychostimulants in medically ill patients with neurological disease and major depression. Can J Psychiatry 29: 46

    PubMed  CAS  Google Scholar 

  • Keller M, Klerman G, Lavori PW, Coryell W, Endicott J, Taylor J (1984) Long-term outcome of episodes of major depression. JAMA 252: 788–792

    Article  PubMed  CAS  Google Scholar 

  • King DJ (1986) Drug-induced psychiatric syndromes. Prescribers J 26 (3): 50

    Google Scholar 

  • Moscovich D, Mester R (1984) Tricyclic antidepressive treatment reinforced by reserpine. Isr J Psychiatry Relat Sci 21: 283–289

    PubMed  CAS  Google Scholar 

  • Murphy E (1983) The prognosis of depression in old age. Br J Psychiatry 142: 111–119

    Article  PubMed  CAS  Google Scholar 

  • Nelson JC, Byck R (1982) Rapid response to lithium in phenelzine non-responders. Br J Psychiatry 141: 85–86

    Article  PubMed  CAS  Google Scholar 

  • Neubauer H, Bermingham P (1976) A depressive syndrome responsive to lithium. J Nerv Ment Dis 163: 276–281

    Article  PubMed  CAS  Google Scholar 

  • Pare CMB (1963) Potentiation of a monoamine oxidase inhibitor by tryptophan. Lancet 11: 527–528

    Article  Google Scholar 

  • Pöldinger W (1963) Combined administration of desimipramine and reserpine or tetrabenazine in depressive patients. Psychopharmacologie (Berlin) 4: 308–310

    Article  Google Scholar 

  • Post F (1972) The management and nature of depressive illness in late life — a follow through study. Br J Psychiatry 121: 393–404

    Article  PubMed  CAS  Google Scholar 

  • Prange AJ, Wilson IC, Rabon AM, Lipton MA (1969) Enhancement of imipramine antidepressant activity by thyroid hormone. Am J Psychiatry 126: 457–469

    PubMed  CAS  Google Scholar 

  • Price LH, Conwell Y, Nelson JC (1983) Lithium augmentation of combined neuroleptic-tricyclic treatment in delusional depression. Am J Psychiatry 140: 318–322

    PubMed  CAS  Google Scholar 

  • Price LH, Charney DS, Heninger GR (1985) Efficacy of lithium-tranylcypromine treatment in refractory depression. Am J Psychiatry 142: 619–623

    PubMed  CAS  Google Scholar 

  • Quitkin FM, Rabkin JG, Ross D, McGrath PJ (1984) Duration of antidepressant drug treatment. Arch Gen Psychiatry 41: 238–245

    Article  PubMed  CAS  Google Scholar 

  • Razani J, White KL, White J, Simpson G, Sloane RB, Rebal R, Palmer R (1983) The safety and efficacy of combined amitriptyline and tranylcypromine antidepressant treatment. Arch Gen Psychiatry 40: 657–661

    Article  PubMed  CAS  Google Scholar 

  • Roos B-E (1976) Tryptophan, 5-hydroxytryptophan and tricyclic antidepressants in the treatment of depression. Monogr Neural Sci 3: 23–25

    PubMed  CAS  Google Scholar 

  • Shaw DM, MacSweeney DA, Hewland R, Johnson L (1975) Tricyclic antidepressants and tryptophan in unipolar depression. Psychol Med 5: 276–278

    Article  PubMed  CAS  Google Scholar 

  • Simpson GM, Lee JM, Cuculica A, Kellner R (1976) Two dosages of imipramine in hospitalized endogenous and neurotic depressives. Arch Gen Psychiatry 33: 1093–1102

    Article  PubMed  CAS  Google Scholar 

  • Thomson J, Rankin H, Ashcroft GW, Yates CM, McQueen JK, Cummings SW (1982) The treatment of depression in general practice: a comparison of 1-tryptophan, amitriptyline, and a combination of 1-tryptophan and amitriptyline with placebo. Psychol Med 12: 741–751

    Article  PubMed  CAS  Google Scholar 

  • von Faust V, Hole G, Wolfesdorf M (1986) Die sogenannte therapieresistente Depression. Fortschr Med 104: 23–24

    Google Scholar 

  • Walinder J, Skott A, Carlsson A, Nagy A, Roos B-E (1976) Potentiation of the antidepressant action of clomipramine by tryptophan. Arch Gen Psychiatry 33: 1384–1389

    Article  PubMed  CAS  Google Scholar 

  • Walinder J, Carlsson A, Persson R (1981) 5HT reuptake inhibitors plus tryptophan in endogenous depression. Acta Psychiatr Scand 63 (Suppl 290 ): 179–190

    Google Scholar 

  • Watt DC, Crammer JL, Elkes A (1972) Metabolism, anticholinergic effects and therapeutic effects on outcome of desmethylimipramine in depressive illness. Psychol Med 2: 397–405

    Article  PubMed  CAS  Google Scholar 

  • Wharton RN, Perel JM, Dayton PG, Malitz S (1971) A potential clinical use for methylphenidate with tricyclic antidepressants. Am J Psychiatry 127: 1619–1625

    PubMed  CAS  Google Scholar 

  • White K, Simpson G (1984) The combined use of MAOIs and tricyclics. J Clin Psychiatry 457 (2): 67–69

    Google Scholar 

  • Young JPR, Lader MH, Hughes MC (1979) Controlled trial of trimipramine, monoamine oxidase inhibitors, and combined treatment in depressed outpatients. Br Med J 2: 1315–1317

    Article  PubMed  CAS  Google Scholar 

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Author information

Authors and Affiliations

  1. Department of Psychological Medicine, University of Wales College of Medicine, Whitchurch Hospital, Cardiff, CF4 7XB, UK

    D. M. Shaw

Authors
  1. D. M. Shaw
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Editors and Affiliations

  1. Oregon Health Sciences University, Veterans Hospital Road, 97207, Portland, OR, USA

    Daniel E. Casey MD (Chief, Psychiatry Research V.A. Medical Center, and Professor of Psychiatry) (Chief, Psychiatry Research V.A. Medical Center, and Professor of Psychiatry)

  2. Department E, Sct. Hans Hospital, DK-4000, Roskilde, Denmark

    A. Vibeke Christensen D. Sc.

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© 1988 Springer-Verlag Berlin Heidelberg

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Shaw, D.M. (1988). Pharmacological Management of Treatment-Resistant Depression. In: Casey, D.E., Christensen, A.V. (eds) Psychopharmacology: Current Trends. Psychopharmacology Series, vol 5. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-642-73280-5_11

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  • DOI: https://doi.org/10.1007/978-3-642-73280-5_11

  • Publisher Name: Springer, Berlin, Heidelberg

  • Print ISBN: 978-3-642-73282-9

  • Online ISBN: 978-3-642-73280-5

  • eBook Packages: Springer Book Archive

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