Current Concepts

Pharmacologic Treatment Strategies for the Depressed, Poorly Responsive Patient

Authors: RAYMOND PARY, MD, CARMELITA R. TOBIAS, MD, STEVEN LIPPMANN, MD

Abstract

Treatment-resistant depression implies a failure of response to an ample dose of antidepressant medicine, prescribed over a sufficient length of time. Assessing drug levels in the blood is often helpful in confirming the adequacy of antidepressant dosages. Augmentation of the pharmaceutical activity can be achieved by coadministration of lithium, triiodothyronine, and/or stimulants. Neuroleptics are also prescribed with the antidepressant when psychotic features accompany depression. Such enhancements to drug efficacy are usually an advantage over beginning a new medication because of shorter response time. When a decision is made to change the antidepressant, a structurally different option is more likely to induce a remission than a medication of similar configuration. Electroconvulsive therapy is the most powerful treatment choice for depressed patients, especially when suicidal or psychotic features are present.

This content is limited to qualifying members.

Existing members, please login first.

If you have an existing account please login now to access this article or view your purchase options.

Purchase only this article ($15)

Create a free account, then purchase this article to download or access it online for 24 hours.

Purchase an SMJ online subscription ($75)

Create a free account, then purchase a subscription to get complete access to all articles for a full year.

Purchase a membership plan (fees vary)

Premium members can access all articles plus recieve many more benefits. View all membership plans and benefit packages.

References