PMID: 28525197May 20, 2017Paper

Treatment resistant depression: actuality and perspectives in 2017

Revue médicale de Bruxelles
N LucasF Jurysta

Abstract

Major depressive disorder (MDD) affects 3 to 17 % of adults. 15 to 30 % of patients with MDD suffer from treatment resistant depression (TRD). No international consensus defines TRD. The most common definition is " MDD that is not enough improved after two successive and different classes of antidepressant treatments in appropriate dose and duration ". The appropriate dose corresponds to maximal dose accepted by scientific reports and clinical recommendations, while the appropriate duration is around 6 weeks. TRD is diagnosed after excluding a pseudoresistant depression, that is related to weak compliance or to somatic and psychiatric differential diagnosis. As well as in MDD, molecular, neuro-anatomical and metabolic disturbances are involved in TRD. A decreased cerebral plasticity induced by low level of Brain-Derived Neurotrophic Factor (BDNF) is also reported. Several authors describe that the cerebral atrophy and the dopaminoglutaminergic system disturbances are more severe in TRD than in MDD. In contrast to MDD treatment, TRD treatment is most often physical treatment. Electroconvulsive therapy (ECT) followed by a tricyclic antidepressant and/or lithium is the most effective treatment. Deep brain stimulation and vagal ner...Continue Reading

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