The current definition of remission from major depressive disorder does not fully take into account all aspects of patient recovery. Residual symptoms of depression are very common in patients who are classified as being in remission. Patients with residual symptoms are at increased risk of functional and interpersonal impairments, and are at high risk for recurrence of depression. This article discusses the incidence of residual symptoms of depression, as well as the risks and consequences of these symptoms, and will review the state of current treatment.
References
[1]
Trivedi, M.H.; Rush, A.J.; Wisniewski, S.R.; Nierenberg, A.A.; Warden, D.; Ritz, L.; Norquist, G.; Howland, R.H.; Lebowtiz, B.D.; McGrath, P.J.; et al. Evaluation of outcomes with citalopram for depression using measurement-based care in STAR*D, implications for clinical practice. Am. J. Psychiatry？2006, 163, 28–40. 16390886
[2]
Israel, J.A. Remission in depression, definition and initial treatment approaches. J. Psychopharmacol.？2006, 20, 5–10, doi:10.1177/1359786806064306. 16785279
[3]
Keller, M.B. Past, Present, and Future Directions for Defining Optimal Treatment Outcome in Depression, Remission and Beyond. JAMA？2003, 289, 3152–3160, doi:10.1001/jama.289.23.3152. 12813121
[4]
Lecrubier, Y. How do you define remission? Acta Psychiatr. Scand.？2002, 415, 7–11, doi:10.1034/j.1600-0447.106.s415.2.x.
[5]
Frank, E.; Prien, R.F.; Jarrett, R.B.; Keller, M.B.; Kupfer, D.J.; Lavori, P.W.; Rush, A.J.; Weissman, M.M. Conceptualization and rationale for consensus definitions of terms in major depressive disorder. Remission, recovery, relapse, and recurrence. Arch. Gen. Psychiatry？1991, 48, 851–855. 1929776
[6]
Nierenberg, A.A.; DeCecco, L.M. Definitions of antidepressant treatment response, remission, nonresponse, partial response, and other relevant outcomes, a focus on treatment-resistant depression. J. Clin. Psychiatry？2001, 62, 5–9. 11806489
[7]
Cuffel, B.J.; Azocar, F.; Tomlin, M.; Greenfield, S.F.; Busch, A.B.; Croghan, T.W. Remission, residual symptoms, and nonresponse in the usual treatment of major depression in managed Clinical Practice. J. Clin. Psychiatry？2003, 64, 397–402, doi:10.4088/JCP.v64n0406. 12716239
[8]
Rush, A.J.; Trivedi, M.H.; Wisniewski, S.R.; Nierenberg, A.A.; Stewart, J.W.; Warden, D.; Niederehe, G.; Thase, M.E.; Lavori, P.W.; Lebowitz, B.D.; et al. Acute and longer-term outcomes in depressed outpatients requiring one or several treatment steps, a STAR*D report. Am. J. Psychiatry？2006, 163, 1905–1917. 17074942
[9]
Rush, A.J.; Kraemer, H.C.; Sackeim, H.A.; Fava, M.; Trivedi, M.D.; Frank, E.; Ninan, P.T.; Thase, M.E.; Gelenberg, A.J.; Kupfer, D.J.; Regier, D.A.; Rosenbaum, J.F.; Ray, O.; Schatzberg, A.F. Report by the ACNP Task Force on response and remission in major depressive disorder. Neuropsychopharmacology？2006, 31, 1841–1853. 16794566
[10]
Zimmerman, M.; McGlinchey, J.B.; Posternak, M.A.; Friedman, M.; Attiullah, N.; Boerescu, D. How should remission from depression be defined? The depressed patient's perspective. Am. J. Psychiatry？2006, 163, 148–50. 16390903
[11]
Keller, M.B. Remission versus response, the new gold standard of antidepressant care. J Clin Psychiatry？2004, 65 (Suppl. 4), 53–9. 15046542
[12]
Zimmerman, M.; Posternak, M.A.; Chelminski, I. Heterogeneity among depressed outpatients considered to be in remission. Compr. Psychiatry？2007, 48, 113–117, doi:10.1016/j.comppsych.2006.10.005. 17292700
[13]
Fava, G.A.; Grandi, S.; Zielezny, M.; Canestrari, R.; Morphy, M.A. Cognitive behavioral treatment of residual symptoms in primary major depressive disorder. Am. J. Psychiatry？1994, 151, 1295–1299. 8067483
[14]
Gastó, C.; Navarro, V.; Catalán, R.; Portella, M.J.; Marcos, T. Residual symptoms in elderly major depression remitters. Acta Psychiatr. Scand.？2003, 108, 15–19. 12807372
[15]
Nierenberg, A.A.; Keefe, B.R.; Leslie, V.C.; Alpert, J.E.; Pava, J.A.; Worthington, J.J.; Rosenbaum, J.F.; Fava, M. Residual symptoms in depressed patients who respond acutely to fluoxetine. J. Clin. Psychiatry？1999, 60, 221–225, doi:10.4088/JCP.v60n0403. 10221281
[16]
Quitkin, F.M.; Petkova, E.; McGrath, P.J.; Taylor, B.; Beasley, C.; Stewart, J.; Amsterdam, J.; Fava, M.; Rosenbaum, J.; Reimherr, F.; Fawcett, J.; Chen, Y.; Klein, D. When should a trial of fluoxetine for major depression be declared failed? Am. J. Psychiatry？2003, 160, 734–740. 12668363
[17]
Mojtabai, R. Residual Symptoms and Impairment in Major Depression in the Community. Am. J.Psychiatry？2001, 158, 1645–1651, doi:10.1176/appi.ajp.158.10.1645. 11578997
[18]
Boulenger, J.P. Residual symptoms of depression, Clinical and theoretical implications. Eur. Psychiatry？2004, 19, 209–213, doi:10.1016/j.eurpsy.2004.04.001. 15196602
[19]
Judd, L.L.; Akiskal, H.S.; Paulus, M.P. The role and Clnical significance of subsyndromal depressive symptoms in unipolar major depressive disorder. J. Affect. Disord.？1997, 45, 5–17, doi:10.1016/S0165-0327(97)00055-4. 9268771
[20]
Pintor, L.; Torres, X.; Navarro, V.; Matrai, S.; Gastó, C. Is the type of remission after a major depressive episode an important risk factor to relapses in a 4-year follow up? J. Affect. Disord.？2004, 82, 291–296, doi:10.1016/j.jad.2003.11.008. 15488260
[21]
Paykel, E.S.; Ramana, R.; Cooper, Z.; Hayhurst, H.; Kerr, J.; Barocka, A. Residual symptoms after partial remission, an important outcome in depression. Psychol. Med.？1995, 25, 1171–1180, doi:10.1017/S0033291700033146. 8637947
[22]
Judd, L.L.; Akiskal, H.S.; Maser, J.D.; Zeller, P.J.; Endicott, J.; Coryell, W.; Paulus, M.P.; Kunovac, J.L.; Leon, A.C.; Mueller, T.I.; Rice, J.A.; Keller, M.B. Major depressive disorder, A prospective study of residual subthreshold depressive symptoms as predictor of rapid relapse. J. Affect. Disord.？1998, 50, 97–108, doi:10.1016/S0165-0327(98)00138-4. 9858069
[23]
Thase, M.E.; Simons, A.P.; McGeary, J.; Cahalane, J.F.; Hughes, C.; Harden, T.; Friedman, E. Relapse after cognitive behavior therapy of depression, potential implications for longer courses of treatment. Am. J. Psychiatry？1992, 149, 1046–52. 1636804
[24]
Judd, L.L.; Paulus, M.J.; Schettler, P.J.; Akiskal, H.S.; Endicott, J.; Leon, A.C.; Maser, J.D.; Mueller, T.; Solomon, D.A.; Keller, M.B. Does Incomplete Recovery From First Lifetime Major Depressive Episode Herald a Chronic Course of Illness? Am. J. Psychiatry？2000, 157, 1501–1504. 10964869
[25]
Carney, C.E.; Segal, Z.V.; Edinger, J.D.; Krystal, A.D. A comparison of rates of residual insomnia symptoms following pharmacotherapy or cognitive-behavioral therapy for major depressive disorder. J. Clin. Psychiatry？2007, 68, 254–260, doi:10.4088/JCP.v68n0211. 17335324
[26]
Nierenberg, A.A.; Keefe, B.R.; Leslie, V.C.; Alpert, J.E.; Pava, J.A.; Worthington, J.J.; Rosenbaum, J.F.; Fava, M. Residual symptoms in depressed patients who respond acutely to fluoxetine. J. Clin. Psychiatry？1999, 60, 221–225, doi:10.4088/JCP.v60n0403. 10221281
[27]
Opdyke, K.S.; Reynolds, C.F.; Frank, E.; Begley, A.E.; Buysse, D.J.; Dew, M.A.; Mulsant, B.H.; Shear, M.K.; Mazumdar, S.; Kupfer, D.J. Effect of continuation treatment on residual symptoms in late-life depression, how well is “well”? Depress. Anxiety？1996/97, 4, 312–319. 9166659
[28]
Merens, W.; Booij, L.; Van Der Does, A.J. Residual cognitive impairments in remitted depressed patients. Depress. Anxiety？2007, 25, E27–36.
[29]
Ohayon, M.M.; Roth, T. Place of chronic insomnia in the course of depressive and anxiety disorders. J. Psychiatr. Res.？2003, 37, 9–15, doi:10.1016/S0022-3956(02)00052-3. 12482465
[30]
Dombrovski, A.Y.; Cyranowski, J.M.; Mulsant, B.H.; Houck, P.R.; Buysse, D.J.; Andreescu, C.; Thase, M.E.; Mallinger, A.G.; Frank, E. Which symptoms predict recurrence of depression in women treated with maintenance interpersonal psychotherapy? Depress. Anxiety？2008, 25, 1060–1066, doi:10.1002/da.20467. 18781665
[31]
Thase, M.E.; Simons, A.D.; Reynolds, C.F. Abnormal electroencephalographic sleep profiles in major depression, association with response to cognitive behavior therapy. Arch. Gen. Psychiatry？1996, 53, 99–108, doi:10.1001/archpsyc.1996.01830020013003. 8629894
Kupfer, D.J.; Frank, E.; McEachran, A.B.; Grochocinski, V.J. Delta sleep ratio, a biological correlate of early recurrence in unipolar affective disorder. Arch. Gen. Psychiatry？1990, 47, 1100–1105, doi:10.1001/archpsyc.1990.01810240020004. 2244794
[34]
Dew, M.A.; Reynolds, C.F.; Houck, P.R.; Hall, M.; Buysse, D.J.; Frank, E.; Kupfer, D.J. Temporal profiles of the course of depression during treatment. Predictors of pathways toward recovery in the elderly. Arch. Gen. Psychiatry？1997, 54, 1016–1024. 9366658
[35]
Bernert, R.A.; Joiner, T.E. Sleep disturbances and suicide risk, A review of the literature. Neuropsychiatr. Dis. Treat.？2007, 3, 737–743.
[36]
Andreescu, C.; Lenze, E.J.; Dew, M.A.; Begley, A.E.; Mulsant, B.H.; Dombrovski, A.Y.; Pollock, B.G.; Stack, J.; Miller., M.D.; Reynolds, C.F. Effect of comorbid anxiety on treatment response and relapse risk in late-life depression, controlled study. Br. J. Psychiatry？2007, 190, 344–349, doi:10.1192/bjp.bp.106.027169. 17401042
[37]
Hybels, C.F.; Steffens, D.C.; McQuoid, D.R.; Rama Krishnan, K.R. Residual symptoms in older patients treated for major depression. Int. J. Geriatr. Psychiatry？2005, 20, 1196–202, doi:10.1002/gps.1418. 16315146
[38]
Helmchen, H.; Linden, M. Subthreshold disorders in psychiatry, clinical reality, methodological artifact, and the double-threshold problem. Compr. Psychiatry？2000, 41, 1–7. 10746897
[39]
Barlow, D.H.; Campbel, L.A. Mixed anxiety–depression and its implications for models of mood and anxiety disorders. Compr. Psychiatry？2000, 41, 55–60, doi:10.1016/S0010-440X(00)80009-7. 10746905
[40]
Fava, G.A.; Grandi, S.; Canestrari, R.; Molnar, G. Prodromal symptoms in primary major depressive disorder. J. Affect. Disord.？1990, 19, 149–152, doi:10.1016/0165-0327(90)90020-9. 2142701
[41]
Tranter, R.; O’Donovan, C.; Chandarana, P.; Kennedy, S. Prevalence and outcome of partial remission in depression. J. Psychiatry Neurosci.？2002, 27, 241–247. 12174733
[42]
Keller, M.B.; Hirschfeld, R.M.; Hanks, D. Double depression, a distinctive subtype of unipolar depression. J. Affect. Disord.？1997, 45, 65–73, doi:10.1016/S0165-0327(97)00060-8. 9268776
[43]
Gilmer, W.S.; Gollan, J.K.; Wisniewski, S.R.; Howland, R.H.; Trivedi, M.H.; Miyahara, S.; Fleck, J.; Thase, M.E.; Alpert, J.E.; Nierenberg, A.A.; et al. Does the Duration of the Index Episode Affect the Treatment Outcome of Major Depressive Disorder? A STAR*D Report. J. Clin. Psychiatry？2007, 69, 1246–1256.
[44]
Keller, M.B.; Boland, R.J. The implications of failing to achieve successful long–term maintenance treatment of recurrent unipolar major depression. Biol. Psychiatry？1998, 44, 348–360, doi:10.1016/S0006-3223(98)00110-3. 9755357
[45]
Fava, M.; Bouffides, E.; Pava, J.A.; McCarthy, M.K.; Steingard, R.J.; Rosenbaum, J.F. Personality disorder comorbidity with major depression and response to fluoxetine treatment. Psychother. Psychosom.？1994, 62, 160–167, doi:10.1159/000288918. 7846259
[46]
Peselow, E.D.; Sanfilipo, M.P.; Fieve, R.R.; Gulbenkian, G. Personality traits during depression and after Clinical recovery. Br. J. Psychiatry？1994, 164, 349–354, doi:10.1192/bjp.164.3.349. 8199788
Fava, G.A.; Rafanelli, C.; Grandi, S.; Canestrari, R.; Morphy, M.A. Six-Year Outcome for Cognitive Behavioral Treatment of Residual Symptoms in Major Depression. Am. J. Psychiatry？1998, 155, 1443–1445. 9766780
[49]
Horsten, M.; Mittleman, M.A.; Wamala, S.P.; Schenck-Gustafsson, K.; Orth-Gomer, K. Depressive symptoms and lack of social integration in relation to prognosis of CHD in middle-aged women. The Stockholm Female Coronary Risk Study. Eur. Heart J.？2000, 21, 1072–1080, doi:10.1053/euhj.1999.2012. 10843825
[50]
Jonas, B.S.; Mussolino, M.E. Symptoms of depression as a prospective risk factor for stroke. Psychosom. Med.？2000, 62, 463–471, doi:10.1097/00006842-200007000-00001. 10949089
[51]
Gastó, C.; Navarro, V.; Catalán, R.; Portella, M.J.; Marcos, T. Residual symptoms in elderly major depression remitters. Acta. Psychiatr. Scand.？2003, 108, 15–19. 12807372
[52]
Mintz, J.; Mintz, L.I.; Arruda, M.J.; Hwang, S.S. Treatments of depression and the functional capacity to work. Arch. Gen. Psychiatry？1992, 49, 761–768, doi:10.1001/archpsyc.1992.01820100005001. 1417427
[53]
Revicki, D.A.; Brown, R.E.; Palmer, W.; Bakish, D.; Rosser, W.W.; Anton, S.F.; Feeny, D. Modeling the cost effectiveness of antidepressant treatment in primary care. Pharmacoeconomics.？1995, 8, 524–540, doi:10.2165/00019053-199508060-00007. 10160081
[54]
Kennedy, N.; Paykel, E.S. Residual symptoms at remission from depression, impact on long-term outcome. J. Affect. Disord.？2004, 80, 135–144, doi:10.1016/S0165-0327(03)00054-5. 15207926
[55]
Hirschfeld, R.M.; Keller, M.B.; Panico, S.; Arons, B.S.; Barlow, D.; Davidoff, F.; Endicott, J.; Froom, J.; Goldstein, M.; Gorman, J.M.; et al. The National Depressive and Manic-Depressive Association consensus statement on the undertreatment of depression. JAMA？1997, 277, 333–340. 9002497
[56]
Sheline, Y.I.; Sanghavi, M.; Mintun, M.; Gado, M.H. Depression Duration But Not Age Predicts Hippocampal Volume Loss in Medically Healthy Women with Recurrent Major Depression. J. Neurosci.？1999, 19, 5034–5043. 10366636
[57]
Trivedi, M.H.; Hollander, E.; Nutt, D.; Blier, P. Clinical evidence and potential neurobiological underpinnings of unresolved symptoms of depression. J. Clin. Psychiatry？2007, 69, 246–258.
[58]
Trivedi, M.H. Major depressive disorder, remission of associated symptoms. J. Clin. Psychiatry？2006, 67, 27–32. 17092193
[59]
Belmaker, R.H.; Agam, G. Major depressive disorder. New Engl. J. Med.？2007, 358, 55–68.
[60]
Keitner, G.I.; Solomon, D.A.; Ryan, C.E.; STAR*D Team. Have We Learned the Right Lessons? Am. J. Psychiatry？2007, 165, 133.
[61]
Kennedy, N.; Abbott, R.; Paykel, E.S. Remission and recurrence of depression in the maintenance era, long-term outcome in a Cambridge cohort. Psychol. Med.？2003, 33, 827–838, doi:10.1017/S003329170300744X. 12877397
[62]
Kessing, L.V.; Hansen, M.G.; Andersen, P.K. Course of illness in depressive and bipolar disorders, naturalistic study, 1994–1999. Br. J. Psychiatry？2004, 185, 372–377, doi:10.1192/bjp.185.5.372. 15516544
[63]
Moller, H.J. Outcomes in major depressive disorder: the evolving concept of remission and its implications for treatment. World J. Biol. Psychiatry？2007, 9, 102–14.
[64]
Israel, J.A. Polypharmacy in Depression. Psychiatric Times？2007, 25, 16–20.
[65]
Thase, M.E. Achieving remission and managing relapse in depression. J. Clin. Psychiatry？2003, 64, 3–7. 14728083
[66]
Souery, D.; Mendlewicz, J. Compliance and therapeutic issues in resistant depression. Int. Clin. Psychopharmacol.？1998, 13, S8–S13.
[67]
Fava, M.; Alpert, J.; Nierenberg, A.A.; Lagomasino, I.; Sonawalla, S.; Tedlow, J.; Worthington, J.; Baer, L.; Rosenbaum, J.F. Double-blind study of high-dose fluoxetine versus lithium or desipramine augmentation of fluoxetine in partial responders and nonresponders to fluoxetine. J. Clin. Psychopharmacol.？2002, 22, 379–387, doi:10.1097/00004714-200208000-00008. 12172337
Rush, A.J.; Trivedi, M.H.; Wisniewski, S.R.; Stewart, J.W.; Nierenberg, A.A.; Thase, M.E.; Ritz, L.; Biggs, M.M.; Warden, D.; Luther, J.F.; Shores-Wilson, K.; et al. Bupropion-SR, sertraline, or venlafaxine-XR after failure of SSRIs for depression. New Engl. J. Med.？2006, 354, 1231–1242, doi:10.1056/NEJMoa052963. 16554525
[70]
Fava, M.; Rush, A.J. Current status of augmentation and combination treatments for major depressive disorder, a literature review and a proposal for a novel approach to improve practice. Psychother. Pychosom.？2006, 75, 139–153.
[71]
Heninger, G.R.; Charney, D.S.; Sternberg, D.E. Lithium carbonate augmentation of antidepressant action, An effective prescription for treatment-refractory depression. Arch. Gen. Psychiatry？1983, 40, 1335–1342. 6418110
[72]
Bauer, M.; Dopfmer, S. Lithium augmentation in treatment-resistant depression, meta-analysis of placebo-controlled studies. J. Clin. Psychopharmacol.？1999, 19, 427–434, doi:10.1097/00004714-199910000-00006. 10505584
[73]
Nierenberg, A.A.; Fava, M.; Trivedi, M.H.; Wisniewski, S.R.; Thase, M.E.; McGrath, P.J.; Alpert, J.E.; Warden, D.; Luther, J.F.; Niederehe, G.; et al. A comparison of lithium and T(3) augmentation following two failed medication treatments for depression, a STAR*D report. Am. J. Psychiatry？2006, 163, 1519–1530. 16946176
[74]
Joffe, R.T.; Singer, W. A comparison of triiodothyronine and thyroxine in the potentiation of tricyclic antidepressants. Psychiatry Res.？1990, 32, 241–251, doi:10.1016/0165-1781(90)90029-5. 2201988
[75]
Valenstein, M.; McCarthy, J.F.; Austin, K.L.; Greden, J.F.; Young, E.A.; Blow, F.C. What happened to lithium? Antidepressant augmentation in clinical settings. Am. J. Psychiatry？2006, 163, 1219–1225, doi:10.1176/appi.ajp.163.7.1219. 16816227
[76]
Trivedi, M.H.; Fava, M.; Wisniewski, S.R.; Thase, M.E.; Quitkin, F.; Warden, D.; Ritz, L.; Nierenberg, A.A.; Lebowitz, B.D.; Biggs, M.M.; Luther, J.F. Medication augmentation after the failure of SSRIs for depression. New Eegl. J. Med.？2006, 354, 1243–1252, doi:10.1056/NEJMoa052964.
[77]
Zimmerman, M.; Posternak, M.A.; Attiullah, N.; Friedman, M.; Boland, R.J.; Baymiller, S.; Berlowitz, S.L.; Rahman, S.; Uy, K.K.; Singer, S.; Chelminski, I. Why isn't bupropion the most frequently prescribed antidepressant? J. Clin. Psychiatry？2005, 66, 603–610. 15889947
[78]
DeBattista, C.; Lembke, A. Update on augmentation of antidepressant response in resistant depression. Curr. Psychiatry Rep.？2005, 7, 435–440, doi:10.1007/s11920-005-0064-x. 16318821
[79]
Carpenter, L.L.; Yasmin, S.; Price, L.H. A double-blind, placebo-controlled study of antidepressant augmentation with mirtazapine. Biol. Psychiatry？2002, 51, 183–188, doi:10.1016/S0006-3223(01)01262-8. 11822997
[80]
Fava, M.; Rush, A.J.; Wisniewski, S.R.; Nierenberg, A.A.; Alpert, J.E.; McGrath, P.J.; Thase, M.E.; Warden, D.; Biggs, M.; Luther, J.F.; et al. A comparison of mirtazapine and nortriptyline following two consecutive failed medication treatments for depressed outpatients, a STAR*D report. Am. J. Psychiatry？2006, 163, 1161–1172. 16816220
[81]
Warden, D.; Rush, A.J.; Trivedi, M.H.; Fava, M.; Wisniewski, S.R. The STAR*D Project results: a comprehensive review of findings. Curr. Psychiatry Rep.？2007, 9, 449–459, doi:10.1007/s11920-007-0061-3. 18221624
[82]
McCall, W.V. What Does Star*D Tell Us about ECT? J. ECT？2007, 23, 1–2, doi:10.1097/01.yct.0000263249.83549.34. 17435561
[83]
Lisanby, S.H. Electroconvulsive Therapy for Depression. New Engl. J. Med.？2007, 357, 1939–1945, doi:10.1056/NEJMct075234. 17989386
[84]
Fink, M.; Taylor, M.A. Electroconvulsive Therapy, Evidence and Challenges. JAMA？2007, 298, 330–332, doi:10.1001/jama.298.3.330. 17635894
[85]
Carpenter, L.L. Neurostimulation in resistant depression. J. Psychopharmacol.？2006, 20, 35–40, doi:10.1177/1359786806064327. 16644770
[86]
DeBattista, C.; Doghramji, K.; Menza, M.A.; Rosenthal, M.H.; Fieve, R.R. Adjunct modafinil for the short-term treatment of fatigue and sleepiness in patients with major depressive disorder, a preliminary double-blind, placebo-controlled study. J. Clin. Psychiatry？2003, 64, 1057–1064, doi:10.4088/JCP.v64n0911. 14628981
[87]
Fava, M. Augmenting antidepressants with folate, a clinical perspective. J. Clin. Psychiatry？2007, 68, 4–7, doi:10.4088/JCP.0207e04. 18307375
[88]
Papakostas, G.I.; Petersen, T.J.; Kinrys, G.; Burns, A.M.; Worthington, J.J.; Alpert, J.E.; Fava, M.; Nierenberg, A.A. Aripiprazole augmentation of selective serotonin reuptake inhibitors for treatment-resistant major depressive disorder. J. Clin. Psychiatry？2005, 66, 1326–1330, doi:10.4088/JCP.v66n1017. 16259548
[89]
Papakostas, G.I.; Petersen, T.J.; Nierenberg, A.A.; Murakami, J.L.; Alpert, J.E.; Rosenbaum, J.F.; Fava, M. Ziprasidone augmentation of selective serotonin reuptake inhibitors (SSRIs) for SSRI-resistant major depressive disorder. J. Clin. Psychiatry？2004, 65, 217–221, doi:10.4088/JCP.v65n0212. 15003076
[90]
Henderson, D.C.; Doraiswamy, P.M. Prolactin-related and metabolic adverse effects of atypical antipsychotic agents. J. Clin. Psychiatry？2007, 69, 32–44.
