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Search Results: 1 - 10 of 19212 matches for " treatment-resistant depression "
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The use of cognitive behavioral therapy in the treatment of resistant depression in adolescents
Hamill-Skoch SK, Hicks P, Prieto-Hicks X
Adolescent Health, Medicine and Therapeutics , 2012, DOI: http://dx.doi.org/10.2147/AHMT.S13781
Abstract: se of cognitive behavioral therapy in the treatment of resistant depression in adolescents Review (1651) Total Article Views Authors: Hamill-Skoch SK, Hicks P, Prieto-Hicks X Published Date September 2012 Volume 2012:3 Pages 95 - 104 DOI: http://dx.doi.org/10.2147/AHMT.S13781 Received: 20 December 2011 Accepted: 27 June 2012 Published: 10 September 2012 Sarah Hamill-Skoch,1 Paul Hicks,2 Ximena Prieto-Hicks1 1Department of Psychiatry, 2Department of Family and Community Medicine, University of Arizona, Tuscon, AZ, USA Abstract: Major depressive disorder often begins in adolescence, is chronic and recurrent, and heightens an individual's risk for major depressive disorder in adulthood. Treatment-resistant depression is a problem for a significant minority of adolescents. Few studies have examined treatments for treatment-resistant depression among adolescents, and even fewer have examined the use of cognitive-behavioral therapy as a monotherapy or in combination with pharmacological treatments. Mental health professionals have a strong interest in understanding what treatments are appropriate for adolescents who are treatment resistant. Preliminary evidence from current published trials indicates that the use of cognitive-behavioral therapy in combination with antidepressant medication yields the best outcome for treatment-resistant depression in adolescents. Secondary analyses also suggest that the utility of cognitive behavioral therapy can be increased by ensuring adolescents receive a therapeutic dose of treatment sessions (more than nine sessions) and the inclusion of two treatment components: social skills and problem solving training. Guidelines for clinicians as well as areas for future research are discussed.
Mechanisms of antidepressant resistance
Wissam El-Hage,Samuel Leman,Vincent Camus,Catherine Belzung
Frontiers in Pharmacology , 2013, DOI: 10.3389/fphar.2013.00146
Abstract: Depression is one of the most frequent and severe mental disorder. Since the discovery of antidepressant (AD) properties of the imipramine and then after of other tricyclic compounds, several classes of psychotropic drugs have shown be effective in treating major depressive disorder (MDD). However, there is a wide range of variability in response to ADs that might lead to non response or partial response or in increased rate of relapse or recurrence. The mechanisms of response to AD therapy are poorly understood, and few biomarkers are available than can predict response to pharmacotherapy. Here, we will first review markers that can be used to predict response to pharmacotherapy, such as markers of drug metabolism or blood-brain barrier (BBB) function, the activity of specific brain areas or neurotransmitter systems, hormonal dysregulations or plasticity, and related molecular targets. We will describe both clinical and preclinical studies and describe factors that might affect the expression of these markers, including environmental or genetic factors and comorbidities. This information will permit us to suggest practical recommendations and innovative treatment strategies to improve therapeutic outcomes.
Treatment-resistant depression: therapeutic trends, challenges, and future directions
Al-Harbi KS
Patient Preference and Adherence , 2012, DOI: http://dx.doi.org/10.2147/PPA.S29716
Abstract: eatment-resistant depression: therapeutic trends, challenges, and future directions Review (3662) Total Article Views Authors: Al-Harbi KS Published Date May 2012 Volume 2012:6 Pages 369 - 388 DOI: http://dx.doi.org/10.2147/PPA.S29716 Received: 05 January 2012 Accepted: 21 February 2012 Published: 01 May 2012 Khalid Saad Al-Harbi Medical College, King Saud Bin Abdulaziz University for Health Sciences, King Abdulaziz Medical City, Riyadh, Kingdom of Saudi Arabia Background: Patients with major depression respond to antidepressant treatment, but 10%–30% of them do not improve or show a partial response coupled with functional impairment, poor quality of life, suicide ideation and attempts, self-injurious behavior, and a high relapse rate. The aim of this paper is to review the therapeutic options for treating resistant major depressive disorder, as well as evaluating further therapeutic options. Methods: In addition to Google Scholar and Quertle searches, a PubMed search using key words was conducted, and relevant articles published in English peer-reviewed journals (1990–2011) were retrieved. Only those papers that directly addressed treatment options for treatment-resistant depression were retained for extensive review. Results: Treatment-resistant depression, a complex clinical problem caused by multiple risk factors, is targeted by integrated therapeutic strategies, which include optimization of medications, a combination of antidepressants, switching of antidepressants, and augmentation with non-antidepressants, psychosocial and cultural therapies, and somatic therapies including electroconvulsive therapy, repetitive transcranial magnetic stimulation, magnetic seizure therapy, deep brain stimulation, transcranial direct current stimulation, and vagus nerve stimulation. As a corollary, more than a third of patients with treatment-resistant depression tend to achieve remission and the rest continue to suffer from residual symptoms. The latter group of patients needs further study to identify the most effective therapeutic modalities. Newer biomarker-based antidepressants and other drugs, together with non-drug strategies, are on the horizon to address further the multiple complex issues of treatment-resistant depression. Conclusion: Treatment-resistant depression continues to challenge mental health care providers, and further relevant research involving newer drugs is warranted to improve the quality of life of patients with the disorder.
Early life stress, HPA axis, and depression
Tofoli, Sandra Marcia de Carvalho;Baes, Cristiane Von Werne;Martins, Camila Maria Severi;Juruena, Mario;
Psychology & Neuroscience , 2011, DOI: 10.3922/j.psns.2011.2.008
Abstract: considerable evidence from various studies suggests a preeminent role for early adverse experiences in the development of psychopathology, especially depression. the most recent studies reviewed herein suggest that early life stressors are associated with an increased risk for mood disorders in adulthood. this review examines the emerging literature on the relationship between stress, hypothalamic-pituitary-adrenal (hpa) axis function, and depression and the role of early life stress as an important risk factor for hpa axis dysregulation. the most consistent findings in the literature show increased activity of the hpa axis in depression associated with hypercortisolemia and reduced inhibitory feedback. moreover, hpa axis changes appear to be state-dependent, tending to improve upon resolution of the depressive syndrome. interestingly, persistent hpa hyperactivity has been associated with higher rates of relapse. these studies suggest that an evaluation of the hpa axis during antidepressant treatment may help identify patients who are at a higher risk for relapse. these findings suggest that this dysregulation of the hpa axis is partially attributable to an imbalance between glucocorticoid and mineralocorticoid receptors. evidence has consistently demonstrated that glucocorticoid receptor function is impaired in major depression, but few studies have assessed the activity of mineralocorticoid receptors in depression. thus, more studies are needed to elucidate this issue.
Early life stress, HPA axis, and depression
Sandra Marcia de Carvalho Tofoli,Cristiane Von Werne Baes,Camila Maria Severi Martins,Mario Juruena
Psychology & Neuroscience , 2011,
Abstract: Considerable evidence from various studies suggests a preeminent role for early adverse experiences in the development of psychopathology, especially depression. The most recent studies reviewed herein suggest that early life stressors are associated with an increased risk for mood disorders in adulthood. This review examines the emerging literature on the relationship between stress, hypothalamic-pituitary-adrenal (HPA) axis function, and depression and the role of early life stress as an important risk factor for HPA axis dysregulation. The most consistent fndings in the literature show increased activity of the HPA axis in depression associated with hypercortisolemia and reduced inhibitory feedback. Moreover, HPA axis changes appear to be state-dependent, tending to improve upon resolution of the depressive syndrome. Interestingly, persistent HPA hyperactivity has been associated with higher rates of relapse. These studies suggest that an evaluation of the HPA axis during antidepressant treatment may help identify patients who are at a higher risk for relapse. These fndings suggest that this dysregulation of the HPA axis is partially attributable to an imbalance between glucocorticoid and mineralocorticoid receptors. Evidence has consistently demonstrated that glucocorticoid receptor function is impaired in major depression, but few studies have assessed the activity of mineralocorticoid receptors in depression. Thus, more studies are needed to elucidate this issue.
Clinical Predictors of Resistance to Antidepressant Therapy
Nargiza F. Yadgarova,Nazira I Khodjaeva PhD, ScD
International Journal of BioMedicine , 2012,
Abstract: The aim of the study was to identify the predictors of treatment-resistant depression (TRD) with positive affectivity. The article presents the results of the examination of 96 patients with TRD. The studied patients were divided into two groups: in the first group consisted of patients with TRD having positive affectivity (n=59), in the second group consisted of patients with curable depression (n=37). The study had shown the highest correlation value of such factors as frequency of depressive episodes, duration and severity of the first depressive episode, the quality of remission after the first depressive episode.
Cognitive correlates of repetitive transcranial magnetic stimulation (rTMS) in treatment-resistant depression- a pilot study
Karina K Kedzior, Vikram Rajput, Greg Price, Joseph Lee, Mathew Martin-Iverson
BMC Psychiatry , 2012, DOI: 10.1186/1471-244x-12-163
Abstract: Patients received forty 20-min sessions of fast-frequency (10 Hz) rTMS of the left dorsolateral prefrontal cortex (DLPFC) over 20 days. Concept-shift ability (accuracy and duration of performance) was assessed daily with a Modified Concept-Shifting Task (mCST) in patients and in eight healthy volunteers. General cognitive functioning test (Repeatable Battery for the Assessment of Neuropsychological Status; RBANS), Beck Depression Inventory (BDI) and Hamilton Depression Rating Scale (HAM-D) were applied before the first and after the last rTMS.Compared to before rTMS on the first 10 days, the patients performed the mCST significantly more accurately after rTMS on the last 10 days (p?<?.001, partial eta squared=.78) while the same comparison in healthy volunteers was not statistically significant (p?=?.256, partial eta squared=.18). A significant improvement in immediate memory on RBANS and reduction in BDI and HAM-D scores were also observed after the last compared to before the first rTMS.The rTMS is associated with an improvement in selective cognitive functions that is not explained by practice effects on tasks administered repeatedly.Name: "Repetitive Transcranial Magnetic Stimulation (rTMS) in the treatment of depression, assessed with HAM-D over a four week period."URL: www.actr.org.auRegistration number: ACTRN012605000145606A repetitive transcranial magnetic stimulation (rTMS) is either a slow-frequency (≤1 Hz) or a fast-frequency (>1 Hz) non-invasive brain stimulation method [1]. A number of meta-analyses have shown that the rTMS appears to have antidepressive properties although the effect sizes were only modest, most likely due to different rTMS protocols adopted and different methods of meta-analysis used for (review see [2,3]). When focusing on the location and frequency of stimulation, it appears that such antidepressive properties are associated specifically with the left frontal fast-frequency rTMS [4]. The rTMS appears especially promising for approxi
Neuromodulation therapies and treatment-resistant depression
Al-Harbi KS, Qureshi NA
Medical Devices: Evidence and Research , 2012, DOI: http://dx.doi.org/10.2147/MDER.S33198
Abstract: romodulation therapies and treatment-resistant depression Review (1866) Total Article Views Authors: Al-Harbi KS, Qureshi NA Published Date July 2012 Volume 2012:5 Pages 53 - 65 DOI: http://dx.doi.org/10.2147/MDER.S33198 Received: 22 April 2012 Accepted: 13 May 2012 Published: 13 July 2012 Khalid Saad Al-Harbi,1 Naseem Akhtar Qureshi2 1National Guard Hospital, King Abdulaziz Medical City, Riyadh, Saudi Arabia; 2General Administration for Research and Studies and Mental Health and Social Services, Riyadh, Saudi Arabia Background: Patients with treatment-resistant depression (TRD) who showed partial response to pharmacological and psychotherapeutic interventions need a trial of neuromodulation therapies (NTs). Objective: This paper aims to review evidence-based data on the use of NTs in TRD. Method: Using keywords and combined-word strategy, multiple computer searches of PubMed, Google Scholar, Quertle(R), and Medline were conducted for retrieving relevant articles published in English-language peer-reviewed journals (2000–2012). Those papers that addressed NTs in TRD were retained for extensive review. Results: Despite methodological challenges, a range of 30%–93% of TRD patients showed substantial improvement to one of the NTs. One hundred–percent improvement was reported in two single-case studies on deep brain stimulation. Some studies reported no benefits from transcranial direct current stimulation. NTs were reported to have good clinical efficacy, better safety margin, and benign side-effect profile. Data are limited regarding randomized clinical trials, long-term efficacy, and cost-effectiveness of these approaches. Both modified electroconvulsive therapy and magnetic seizure therapy were associated with reversible but disturbing neurocognitive adverse effects. Besides clinical utility, NTs including approaches on the horizon may unlock the biological basis underlying mood disorders including TRD. Conclusion: NTs are promising in patients with TRD, as the majority of them show good clinical response measured by standardized depression scales. NTs need further technological refinements and optimization together with continuing well-designed studies that recruit larger numbers of participants with TRD.
A patient-level meta-analysis of studies evaluating vagus nerve stimulation therapy for treatment-resistant depression
Berry SM, Broglio K, Bunker M, Jayewardene A, Olin B, Rush AJ
Medical Devices: Evidence and Research , 2013, DOI: http://dx.doi.org/10.2147/MDER.S41017
Abstract: patient-level meta-analysis of studies evaluating vagus nerve stimulation therapy for treatment-resistant depression Original Research (606) Total Article Views Authors: Berry SM, Broglio K, Bunker M, Jayewardene A, Olin B, Rush AJ Published Date March 2013 Volume 2013:6 Pages 17 - 35 DOI: http://dx.doi.org/10.2147/MDER.S41017 Received: 01 December 2012 Accepted: 14 January 2013 Published: 01 March 2013 Scott M Berry,1 Kristine Broglio,1 Mark Bunker,2 Amara Jayewardene,2 Bryan Olin,2 A John Rush3 1Berry Consultants, Austin, TX, USA; 2Cyberonics, Inc, Houston, TX, USA; 3Duke-NUS, Office of Clinical Sciences, Singapore Objective: To compare response and remission rates in depressed patients with chronic treatment-resistant depression (TRD) treated with vagus nerve stimulation (VNS) Therapy plus treatment as usual (VNS + TAU) or TAU alone in a meta-analysis using Bayesian hierarchical models. Data sources and study selection: Six outpatient, multicenter, clinical trials that have evaluated VNS + TAU or TAU in TRD, including two single-arm studies of VNS + TAU (n = 60 and n = 74), a randomized study of VNS + TAU versus TAU (n = 235), a randomized study of VNS + TAU comparing different VNS stimulation intensities (n = 331), a nonrandomized registry of VNS + TAU versus TAU (n = 636), and a single-arm study of TAU (n = 124) to provide longer-term, control data for comparison with VNS-treated patients. Data extraction: A systematic review of individual patient-level data based on the intent-to-treat principle, including all patients who contributed more than one post-baseline visit. Response was based on the Montgomery– sberg Depression Rating Scale (MADRS) and the Clinical Global Impressions scale's Improvement subscale (CGI-I), as these were the two clinician-rated measures common across all or most studies. Remission was based on the MADRS. Results: Outcomes were compared from baseline up to 96 weeks of treatment with VNS + TAU (n = 1035) versus TAU (n = 425). The MADRS response rate for VNS + TAU at 12, 24, 48, and 96 weeks were 12%, 18%, 28%, and 32% versus 4%, 7%, 12%, and 14% for TAU. The MADRS remission rate for VNS + TAU at 12, 24, 48, and 96 weeks were 3%, 5%, 10%, and 14% versus 1%, 1%, 2%, and 4%, for TAU. Adjunctive VNS Therapy was associated with a greater likelihood of response (odds ratio [OR] = 3.19, 95% confidence interval [CI]: 2.12, 4.66) and remission (OR = 4.99, CI: 2.93, 7.76), compared with TAU. For patients who had responded to VNS + TAU at 24 weeks, sustained response was more likely at 48 weeks (OR = 1.98, CI: 1.34, 3.01) and at 96 weeks (OR = 3.42, CI: 1.78, 7.31). Similar results were observed for CGI-I response. Conclusion: For patients with chronic TRD, VNS + TAU has greater response and remission rates that are more likely to persist than TAU.
Role of aripiprazole in treatment-resistant schizophrenia
Mossaheb N, Kaufmann RM
Neuropsychiatric Disease and Treatment , 2012, DOI: http://dx.doi.org/10.2147/NDT.S13830
Abstract: le of aripiprazole in treatment-resistant schizophrenia Review (3750) Total Article Views Authors: Mossaheb N, Kaufmann RM Published Date May 2012 Volume 2012:8 Pages 235 - 244 DOI: http://dx.doi.org/10.2147/NDT.S13830 Received: 05 March 2012 Accepted: 29 March 2012 Published: 29 May 2012 Nilufar Mossaheb,1 Rainer M Kaufmann2 1Department of Child and Adolescent Psychiatry, 2Department of Psychiatry and Psychotherapy, Medical University, Vienna, Austria Abstract: About one third of patients with schizophrenia respond unsatisfactorily to antipsychotic treatment and are termed “treatment-resistant”. Clozapine is still the gold standard in these cases. However, 40%–70% of patients do not improve sufficiently on clozapine either. In the search for more efficacious strategies for treatment-resistant schizophrenia, drugs with different pharmacological profiles seem to raise new hopes, but are they valid? The aim of this review was to evaluate the evidence for aripiprazole as a potential strategy in monotherapy or combination therapy for patients with treatment-resistant schizophrenia. The evidence for aripiprazole monotherapy and for the combination of aripiprazole with psychotropics other than clozapine is scant, and no recommendation can be made on the basis of the currently available data. More effort has been made in describing combinations of aripiprazole and clozapine. Most of the open-label and case studies as well as case reports have shown positive effects of this combination on overall psychopathology and to some extent on negative symptoms. Several reports describe the possibility of dose reduction for clozapine in combination with aripiprazole, a strategy that might help so-called “treatment-intolerant” patients. The findings of four randomized controlled trials with respect to changes in psychopathology seem less conclusive. The most commonly found beneficial effects are better metabolic outcomes and indicators of the possibility of reducing the clozapine dose. However, other side effects, such as akathisia, are repeatedly reported. Further, none of the studies report longer-term outcomes. In the absence of alternatives, polypharmacy is a common strategy in clinical practice. Combining aripiprazole with clozapine in clozapine-resistant or clozapine-intolerant patients seems to be worthy of further investigation from the pharmacological and clinical points of view.
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