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treatment-resistant depression

Failure to respond to two antidepressants of adequate duration & dose. - optimal treatment is 4-6 weeks after the target dose is reached - the major predictive factor of treatment resistance is a history of unresponsive depression [1] Management: - treatment-resistant depression likely to respond to cognitive behavioral therapy [2] - patients with anhedonia, abulia, fatigue, or psychomotor retardation should receive treatment with an SNRI [1] - ketamine & electroconvulsive therapy effective [3] - esketamine nasal spray* twice weekly more effective than quetiapine [4] - remission at 8 weeks more likely with esketamine than quetiapine (27% vs 18%) - a single dose of psilocybin 25 mg reduces depression scores with 8 days & over a period of 3-6 weeks [5]

General

depression

References

  1. Bennabi D, Charpeaud T, Yrondi A et al Clinical guidelines for the management of treatment-resistant depression: French recommendations from experts, the French Association for Biological Psychiatry and Neuropsychopharmacology and the fondation FondaMental. BMC Psychiatry. 2019 Aug 28;19(1):262. PMID: 31455302 PMCID: PMC6712810
  2. Geriatrics Review Syllabus, American Geriatrics Society, 5th edition, 2002-2004 - Geriatric Review Syllabus, 7th edition Parada JT et al (eds) American Geriatrics Society, 2010 - Geriatric Review Syllabus, 8th edition (GRS8) Durso SC and Sullivan GN (eds) American Geriatrics Society, 2013 - Geriatric Review Syllabus, 9th edition (GRS9) Medinal-Walpole A, Pacala JT, Porter JF (eds) American Geriatrics Society, 2016 - Geriatric Review Syllabus, 11th edition (GRS11) Harper GM, Lyons WL, Potter JF (eds) American Geriatrics Society, 2022
  3. Anand A et al. Ketamine versus ECT for nonpsychotic treatment-resistant major depression. N Engl J Med 2023 May 24; [e-pub]. PMID: 37224232 https://www.nejm.org/doi/10.1056/NEJMoa2302399 - Freedman R. Ketamine and ECT in depression - Risks and rewards. N Engl J Med 2023 May 24; [e-pub] PMID: 37224235 https://www.nejm.org/doi/10.1056/NEJMe2305130
  4. Reif A et al. Esketamine nasal spray versus quetiapine for treatment-resistant depression. N Engl J Med 2023 Oct 5; 389:1298. PMID: 37792613 https://www.nejm.org/doi/10.1056/NEJMoa2304145
  5. Goodwin GM, Aaronson ST, Alvarez O et al Single-Dose Psilocybin for a Treatment-Resistant Episode of Major Depression. N Engl J Med 2022; 387:1637-1648. Nov 3. PMID: 36322843 https://www.nejm.org/doi/full/10.1056/NEJMoa2206443 - Raison CL, Sanacora G, Woolley J et al Single-Dose Psilocybin Treatment for Major Depressive Disorder. A Randomized Clinical Trial. JAMA. Published online August 31, 2023 PMID: 37651119 https://jamanetwork.com/journals/jama/fullarticle/2808950