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KMID : 1007420070050020069
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Mood and Emotion
2007 Volume.5 No. 2 p.69 ~ p.78
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Treatment of Antidepressant Resistant Depression
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Jeong Jong-Hyun
Bahk Won-Myong
Hong Seung-Chul
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Abstract
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The development of new antidepressants, such as SSRI, has enhanced the therapeutic efficacy and reduced suffering associated with depression. Nevertheless, non-response or partial response to antidepressants is a common problem in the treatment of depression. Approximately 50-70% of patients with major depressive disorder remain without remission state. Antidepressant resistant depression refers to inadequate responses to at least one antidepressant trial of adequate doses and duration. This is a relatively common occurrence and importance in clinical practice. Principles for assessing antidepressant resistant depression include preventing pseudo-resistant case. Diagnostic re-evaluation is also important to proper management in these cases. Particularly, the possible role of several contributing factors such as, psychiatric and medical comorbidity, needs to be taken into evaluation. Non-response may be also result from pharmacodynamic, pharmacokinetic and pharmacogentic factors. Augmentation, the strategy of enhancing the antidepressant efficacy, is particularly attractive for patients with partial response. Lithium, thyroid hormone, buspirone, alpha-2 antagonist, atypical antipsychotics, psychostimulants and E-EPA (Ethyl-eicosapentaenoate) may be a enhancing a antidepressant efficacy as an augmentating agents. Among the non-pharmacologic approaches, ECT shows robust therapeutic effects and safety profiles. Novel nonpharmacologic approaches such as repetitive transcranial stimulation, magnetic seizure therapy, vagal nerve stimulation and deep brain stimulation are being developed, but they require further study before being incorporating into clinical practice. Although systemic literatures about approaching the antidepressant resistant depression are sparse, understanding treatment resistants are helpful in the increasing therapeutic effect, the selection of effective therapeutic agents, and prediction of treatment response and prognosis.
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KEYWORD
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Depression, Antidepressant, Resistant
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