tailieunhanh - Ebook Treatment-Resistant mood disorders: Part 2

(BQ) Part 2 book “Treatment-Resistant mood disorders” has contents: Evidence-based pharmacological approaches for treatment-resistant major depressive disorder, psychosocial management of treatment-resistant mood disorders - current evidence, electroconvulsive therapy for treatment-resistant mood disorders, and other contents. | Chapter 7 Evidence-based pharmacological approaches for treatment-resistant major depressive disorder André F Carvalho, Thomas N Hyphantis, and Roger S McIntyre 7.   Introduction Major depressive disorder (MDD) is a serious, chronic, and recurring mental disorder. The Global Burden of Disease study indicates that MDD is a leading cause of disability adjusted life years worldwide (Murray et al., 20 0). A recent systematic review also demonstrates that MDD is associated with excess mortality irrespective of most chronic comorbid general medical conditions (Cuijpers et al., 20 4). Despite advances in the pharmacological management of MDD, only 30–40 per cent of patients achieve remission following a standard trial with a first-line antidepressant agent (Carvalho et al., 20 4). Patients who met the traditional criteria for treatment response (typically a 50 per cent reduction in depressive symptoms as measured by a validated rating scale) continue to present residual symptoms which are associated with higher recurrence rates and functional impairment (Boulenger et al., 2004). As a result, there is a consensus in the literature that the treatment of depression should aim for remission (Carvalho et al., 20 4). For those MDD patients who do not achieve remission after an adequate antidepressant trial, several so-called second-step approaches have been proposed, including: (i) increasing the dose of the antidepressant; (ii) switching antidepressants; (iii) augmentation therapies; and (iv) antidepressant combination strategies. A clear definition for treatment-resistant depression (TRD) remains elusive. Several lines of evidence indicate that TRD is not an ‘all-or-none’ phenomenon. Several staging systems have been developed (Ruhe et al., 20 2) (see Chapter for a wider discussion on the definitions of treatment-resistant depression). This chapter summarizes available evidences on pharmacological approaches for the management of TRD. Higher-level evidence (. from