Treatment-resistant depression definition

Fava M High-dose fluoxetine in the treatment of depressed patients not responsive to a standard dose of fluoxetine. J Affect Disord 25 229-234, 1992 Fava M, Davidson KG Definition and epiemiology of treatment-resistant depression. 

Nierenberg AA, Amsterdam JD Resistant depression definition and treatment approaches. J Chn Psychiatry 51 (suppl) 39-47, 1990 Nierenberg AA, Adler LA, Peselow E, et al Trazodone for antidepressant-associated insomnia. Am J Psychiatry 151 1069-1072, 1994a Nierenberg AA, Feighner JP, Rudolph R, et al Venlafaxine for treatment-resistant unipolar depression. J Chn Psychopharmacol 14 419-423, 1994b... 

Fava, M. and Davidson, K. G. (1996) Definition and epidemiology of treatment-resistant depression. Psychiatr Clin North Am 19, 179-200. 

Treatment-resistant depression has varying definitions but usually refers to a failttre to... 

Fava M. Diagnosis and definition of treatment resistant depression. Biol Psychiatry 2003 53 649-659. 

Approximately 30-40% of patients will not respond to a given antidepressant and 60-75% may fail to achieve complete remission [16]. Consequently, in its least restricted definition, treatment resistance could be detected in the majority of depressed patients under treatment. Moreover, prior treatment failure negatively influences the response to subsequent antidepressant treatment, decreasing the odds of treatment response by a factor of 15-20% for each failed treatment [17]. The delayed onset of symptom relief (which takes three to eight weeks to occur) and the presence of adverse drug reactions contribute significantly to low treatment compliance. 

It has been estimated that at least 30% of patients with major depression fail to respond to a 6-week course of a TCA antidepressant. A major problem arises however in the definition of "treatment resistance". To date, there appears to be no internationally acceptable definition of the condition. A practical definition which many clinicians find useful is that treatment resistance occurs when the patient fails to respond to ... 

Controlled studies involving lipid manipulation in children date back to the 1920s, when the ketogenic diet was pioneered to control treatment-resistant seizures in select pediatric populations (Freeman et al., 1998). However, no controlled evidence is available in children with depression, bipolar disorder, behavioral problems, or ADHD. In the absence of definite empirical data about effectiveness, treatment with EFA supplements should be considered unproven and patients ought to be advised accordingly. 

Before making a definitive diagnosis of a primary depression or concluding the existence of treatment resistance, one must consider the possibility of another concurrent, confounding medical or psychiatric disorder, in addition to depression. 

The mood stabilizer lithium was developed as the first treatment for bipolar disorder. It has definitely modified the long-term outcome of bipolar disorder because it not only treats acute episodes of mania, but it is the first psychotropic drug proven to have a prophylactic effect in preventing future episodes of illness. Lithium even treats depression in bipolar patients, although it is not so clear that it is a powerful antidepressant for unipolar depression. Nevertheless, it is used to augment antidepressants for treating resistant cases of unipolar depression. 

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