Treatment-Resistant Depression
Treatment-resistant depression
Although there is no generally accepted definition of treatment-resistant depression, NICE defines treatment-resistant depression as that which fails to respond to two or more antidepressants given sequentially at an adequate dose for an adequate time. David Christmas (2011) has published a particularly helpful algorithm to be used for the management of such treatment-refractory depression in primary care. The steps in this algorithm are as follows.
Lack of response?
If yes, then has a co-morbid diagnosis (such as anxiety disorder or substance misuse) been ruled out? If not, then review whether separate/additional treatment is required, which in many cases may be psychological.
If yes, then has the antidepressant dose been optimized and has the patient been taking it for an adequate duration? If not, then titrate to the maximum-tolerated dose and give this for either 6-8 weeks if there are no complicating factors, or for 10-12 weeks if co-morbid conditions are present.
If yes, then check whether the depressive episode has lasted for more than 2 years. If not, then consider the role of psychological therapy (if readily available).Related posts:
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