Pharmacological approaches to the challenge of treatment-resistant depression

Dawn F. Ionescu, Jerrold F. Rosenbaum, Jonathan E. Alpert

Research output: Contribution to journalArticle

37 Citations (Scopus)

Abstract

Although monoaminergic antidepressants revolutionized the treatment of Major Depressive Disorder (MDD) over a half-century ago, approximately one third of depressed patients experience treatment-resistant depression (TRD). Such patients account for a disproportionately large burden of disease, as evidenced by increased disability, cost, human suffering, and suicide. This review addresses the definition, causes, evaluation, and treatment of unipolar TRD, as well as the major treatment strategies, including optimization, augmentation, combination, and switch therapies. Evidence for these options, as outlined in this review, is mainly focused on large-scale trials or meta-analyses. Finally, we briefly review emerging targets for antidepressant drug discovery and the novel effects of rapidly acting antidepressants, with a focus on ketamine.

Original languageEnglish (US)
Pages (from-to)111-126
Number of pages16
JournalDialogues in Clinical Neuroscience
Volume17
Issue number2
StatePublished - 2015
Externally publishedYes

Fingerprint

Treatment-Resistant Depressive Disorder
Pharmacology
Antidepressive Agents
Major Depressive Disorder
Ketamine
Drug Discovery
Therapeutics
Psychological Stress
Suicide
Meta-Analysis
Costs and Cost Analysis

Keywords

  • Augmentation
  • Combination
  • Ketamine
  • Optimization
  • Scopolamine
  • Switch therapy
  • Treatment strategy
  • Treatment-resistant depression

ASJC Scopus subject areas

  • Psychiatry and Mental health
  • Biological Psychiatry

Cite this

Pharmacological approaches to the challenge of treatment-resistant depression. / Ionescu, Dawn F.; Rosenbaum, Jerrold F.; Alpert, Jonathan E.

In: Dialogues in Clinical Neuroscience, Vol. 17, No. 2, 2015, p. 111-126.

Research output: Contribution to journalArticle

@article{473088bee1804c36a78fe4a79101269f,
title = "Pharmacological approaches to the challenge of treatment-resistant depression",
abstract = "Although monoaminergic antidepressants revolutionized the treatment of Major Depressive Disorder (MDD) over a half-century ago, approximately one third of depressed patients experience treatment-resistant depression (TRD). Such patients account for a disproportionately large burden of disease, as evidenced by increased disability, cost, human suffering, and suicide. This review addresses the definition, causes, evaluation, and treatment of unipolar TRD, as well as the major treatment strategies, including optimization, augmentation, combination, and switch therapies. Evidence for these options, as outlined in this review, is mainly focused on large-scale trials or meta-analyses. Finally, we briefly review emerging targets for antidepressant drug discovery and the novel effects of rapidly acting antidepressants, with a focus on ketamine.",
keywords = "Augmentation, Combination, Ketamine, Optimization, Scopolamine, Switch therapy, Treatment strategy, Treatment-resistant depression",
author = "Ionescu, {Dawn F.} and Rosenbaum, {Jerrold F.} and Alpert, {Jonathan E.}",
year = "2015",
language = "English (US)",
volume = "17",
pages = "111--126",
journal = "Dialogues in Clinical Neuroscience",
issn = "1294-8322",
publisher = "Servier International",
number = "2",

}

TY - JOUR

T1 - Pharmacological approaches to the challenge of treatment-resistant depression

AU - Ionescu, Dawn F.

AU - Rosenbaum, Jerrold F.

AU - Alpert, Jonathan E.

PY - 2015

Y1 - 2015

N2 - Although monoaminergic antidepressants revolutionized the treatment of Major Depressive Disorder (MDD) over a half-century ago, approximately one third of depressed patients experience treatment-resistant depression (TRD). Such patients account for a disproportionately large burden of disease, as evidenced by increased disability, cost, human suffering, and suicide. This review addresses the definition, causes, evaluation, and treatment of unipolar TRD, as well as the major treatment strategies, including optimization, augmentation, combination, and switch therapies. Evidence for these options, as outlined in this review, is mainly focused on large-scale trials or meta-analyses. Finally, we briefly review emerging targets for antidepressant drug discovery and the novel effects of rapidly acting antidepressants, with a focus on ketamine.

AB - Although monoaminergic antidepressants revolutionized the treatment of Major Depressive Disorder (MDD) over a half-century ago, approximately one third of depressed patients experience treatment-resistant depression (TRD). Such patients account for a disproportionately large burden of disease, as evidenced by increased disability, cost, human suffering, and suicide. This review addresses the definition, causes, evaluation, and treatment of unipolar TRD, as well as the major treatment strategies, including optimization, augmentation, combination, and switch therapies. Evidence for these options, as outlined in this review, is mainly focused on large-scale trials or meta-analyses. Finally, we briefly review emerging targets for antidepressant drug discovery and the novel effects of rapidly acting antidepressants, with a focus on ketamine.

KW - Augmentation

KW - Combination

KW - Ketamine

KW - Optimization

KW - Scopolamine

KW - Switch therapy

KW - Treatment strategy

KW - Treatment-resistant depression

UR - http://www.scopus.com/inward/record.url?scp=84940737647&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84940737647&partnerID=8YFLogxK

M3 - Article

C2 - 26246787

AN - SCOPUS:84940737647

VL - 17

SP - 111

EP - 126

JO - Dialogues in Clinical Neuroscience

JF - Dialogues in Clinical Neuroscience

SN - 1294-8322

IS - 2

ER -