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Depression, Treatment Resistant

Michelle Magid, MD and Roger L. McRoberts, III, MD Reviewed 06/2018
 


BASICS

DESCRIPTION

  • Major depressive disorder (MDD) that has failed to respond to ≥2 adequate trials of antidepressant therapy in ≥2 different classes

  • Antidepressant therapy must be given for 6 weeks at ...

DIAGNOSIS

HISTORY

  • Symptoms are the same as in MDD. However, patients do not respond to standard form of treatment. Severity and duration are extreme.

  • Important to screen for suicidality in treatment-res...

TREATMENT

MEDICATION

First Line

  • Please see “Depression” topic. When those fail, augmentation and combination strategies are as follows:

    • Antidepressants in combination

ONGOING CARE

FOLLOW UP RECOMMENDATIONS

  • Frequent visits (i.e., every month)

  • During follow-up, evaluate side effects, dosage, and effectiveness of medication as well as need for referral to ECT.

  • Patients w...

REFERENCES

1
1 Trivedi MH, Fava M, Wisniewski SR, et al; for STAR*D Study Team. Medication augmentation after the failure of SSRIs for depression. N Engl J Med.  2006;354(12):1243–1252. {L-End} ...

CODES

ICD10

  • F32.9 Major depressive disorder, single episode, unspecified

  • F33.9 Major depressive disorder, recurrent, unspecified

ICD9

  • 311 Depressive disorder, not elsewhere classified

  • 296.30 Major depressi...

CLINICAL PEARLS

  • Treatment-resistant depression is common, affecting 1/3 of those with MDD.

  • Combination and augmentation strategies with antidepressants, antipsychotics, therapy, and mood stabilizers ca...

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