Treatment-resistant Depress
Successful management of patients with treatment-resistant depression requires a thorough understanding of the biological basis for both the depression and its failure to respond to standard treatments. This book clearly and succinctly summarizes the latest scientific research and its applications in clinical practice.
A first step is a clear definition of what constitutes treatment-resistant depression so that clinical trials and other studies are using common criteria, enabling comparison and meta-analysis of their outcomes. The opening chapter reviews definitions and predictors of treatment-resistant depression originating from different fields and discusses their usefulness in clinical practice and clinical research. The next chapter proposes a new definition, adapting terminology from medicine.
Biological classification requires identification of genetic risk factors and gene variants have been identified as accounting for 50% of the variance in the clinical outcomes of antidepressant treatments. Chapter 3 describes several genes already associated with treatment-resistant depression and, while further work is needed to translate findings into clinical recommendations, suggests that genetic prediction of treatment resistance could become a widespread clinical reality within a few years.
Most patients with treatment-resistant depression will be treated pharmacologically, so three chapters review the latest evidence for pharmacological best practice in switching strategies for antidepressants, the role of antipsychotics and augmentation strategies to complement lithium.
There are two major alternatives to pharmacotherapy: neuromodulation and psychotherapy. The brain intervention chapter summarizes clinical research and experience with electroconvulsive therapy, transcranial magnetic stimulation, vagus nerve stimulation, deep brain stimulation and magnetic seizure therapy. The final chapter reviews the literature pertaining to the effectiveness of various forms of psychotherapy in patients who have not responded to antidepressant pharmacotherapy, explaining that patients who have not responded to one or two trials of antidepressant medication have a 30%-50% chance of responding to a focused psychotherapy. It proposes indications for psychotherapy in treatment-resistant depression and summarizes general therapeutic principles.
Essential reading for all psychiatrists managing patients with this distressing disorder.
Table of Content
List of Contributors vii
Foreword ix
1 Definitions and Predictors of Treatment-resistant Depression
1
Daniel Souery and William Pitchot
2 Treatment-resistant Depression: A Separate Disorder – A
New Approach 21
Hans-Jürgen Möller, Florian Seemüller, Rebecca
Schennach and Ramesh K. Gupta
3 Genetics of Treatment-resistant Depression 43
Chiara Fabbri, Stefano Porcelli and Alessandro Serretti
4 Is There a Role for Switching Antidepressants in
Treatment-resistant Depression? 91
Stuart Montgomery
5 The Role of Atypical Antipsychotics in Inadequateresponse and
Treatment-resistant Depression 107
Siegfried Kasper and Elena Akimova
6 Lithium, Thyroid Hormones and Further Augmentation Strategies
in Treatment-resistant Depression 129
Robert Haußmann and Michael Bauer
7 The Role of Nonpharmacological Interventions in
Treatment-resistant Depression 159
Thomas E. Schläpfer and Sarah Kayser
8 The Role of Psychotherapy in the Management of
Treatment-resistant Depression 183
Michael E. Thase
Index 209
About the author
Professor Dr Kasper is Professor of Psychiatry and Chairman
of the Department of General Psychiatry at the Medical University
of Vienna, Austria. He is Honorary Professor at the University of
Hong Kong, China. He concentrates on the biological bases of
mental disorders and their possible treatment approaches. He has
conducted studies in psychopathological as well as clinical areas.
Dr Kasper is a frequent national and international speaker and is
actively involved in research programmes studying depression,
anxiety, psychosis, and dementia, authoring over 800 research
reports and reviews. Dr Kasper serves on the editorial boards of
numerous learned journals, including European Archives of
Psychiatry and Neuroscience, European Psychiatry, and European
Neuropsychopharmacology. He is Co-editor in-chief of the
International Journal of Psychiatry in Clinical Practice.
Professor Montgomery was Professor of Psychiatry at
Imperial College, University of London until his retirement in 1996
when he became Emeritus Professor of Psychiatry. He has great
breadth of experience in the field of psychotropic medicine with
seminal work in depression, anxiety disorders, suicide prevention
and schizophrenia. He has published 26 books and more than 400
papers. Professor Montgomery is editor of International Clinical
Psychopharmacology and was editor of European
Neuropsychopharmacology for 20 years. He also serves on the
editorial board of numerous scientific journals.
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