5-Minute Clinical Consult
Depression, Treatment Resistant
Depression, Treatment Resistant is a topic covered in the 5-Minute Clinical Consult.
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Basics
Description
- Major depressive disorder (MDD) that has failed to respond to ≥2 adequate trials of antidepressant therapy in ≥2 different classes
- Individual antidepressants must be given for 6 weeks at standard doses before being considered a failure.
Epidemiology
- Depression affects >16 million people in the United States and >350 million people worldwide.
- The average adult has a 16% lifetime risk of MDD, with majority experiencing onset before the age of 30
- Approximately 1/3 of patients with MDD will develop treatment-resistant depression.
Etiology and Pathophysiology
- Unclear. Low levels of neurotransmitters (serotonin, norepinephrine, dopamine) have been indicated.
- Serotonin has been linked to irritability, hostility, and suicidal ideation.
- Norepinephrine has been linked to low energy.
- Dopamine may play a role in low motivation and depression with psychotic features.
- Environmental stressors, such as abuse and neglect, may affect both the function and levels of neurotransmitters.
- Inflammation and oxidative stress in the brain can contribute to treatment-resistant depression.
Genetics
A genetic abnormality in the serotonin transporter gene (5-HTTLPR) may increase risk for treatment-resistant depression.
Risk Factors
- Severity of disease
- Mislabeling bipolar patients as depressed
- Comorbid medical disease (including chronic pain)
- Comorbid personality disorder
- Comorbid anxiety disorder
- Comorbid substance use disorder
- Genetic familial predisposition to poor response to antidepressants
General Prevention
- Medication adherence in combination with psychotherapy
- Maintenance electroconvulsive therapy (ECT) may prevent relapse.
Commonly Associated Conditions
- Suicide
- Bipolar disorder
- Substance use disorders
- Anxiety disorders
- Dysthymia
- Eating disorders
- Somatic symptom disorders
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Basics
Description
- Major depressive disorder (MDD) that has failed to respond to ≥2 adequate trials of antidepressant therapy in ≥2 different classes
- Individual antidepressants must be given for 6 weeks at standard doses before being considered a failure.
Epidemiology
- Depression affects >16 million people in the United States and >350 million people worldwide.
- The average adult has a 16% lifetime risk of MDD, with majority experiencing onset before the age of 30
- Approximately 1/3 of patients with MDD will develop treatment-resistant depression.
Etiology and Pathophysiology
- Unclear. Low levels of neurotransmitters (serotonin, norepinephrine, dopamine) have been indicated.
- Serotonin has been linked to irritability, hostility, and suicidal ideation.
- Norepinephrine has been linked to low energy.
- Dopamine may play a role in low motivation and depression with psychotic features.
- Environmental stressors, such as abuse and neglect, may affect both the function and levels of neurotransmitters.
- Inflammation and oxidative stress in the brain can contribute to treatment-resistant depression.
Genetics
A genetic abnormality in the serotonin transporter gene (5-HTTLPR) may increase risk for treatment-resistant depression.
Risk Factors
- Severity of disease
- Mislabeling bipolar patients as depressed
- Comorbid medical disease (including chronic pain)
- Comorbid personality disorder
- Comorbid anxiety disorder
- Comorbid substance use disorder
- Genetic familial predisposition to poor response to antidepressants
General Prevention
- Medication adherence in combination with psychotherapy
- Maintenance electroconvulsive therapy (ECT) may prevent relapse.
Commonly Associated Conditions
- Suicide
- Bipolar disorder
- Substance use disorders
- Anxiety disorders
- Dysthymia
- Eating disorders
- Somatic symptom disorders
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Citation
Stephens, Mark B., et al., editors. "Depression, Treatment Resistant." 5-Minute Clinical Consult, 27th ed., Wolters Kluwer, 2020. Medicine Central, im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/117633/all/Depression__Treatment_Resistant.
Depression, Treatment Resistant. In: Stephens MB, Golding J, Baldor RA, et al, eds. 5-Minute Clinical Consult. Wolters Kluwer; 2020. https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/117633/all/Depression__Treatment_Resistant. Accessed August 11, 2020.
Depression, Treatment Resistant. (2020). In Stephens, M. B., Golding, J., Baldor, R. A., & Domino, F. J. (Eds.), 5-Minute Clinical Consult (27th edition). Wolters Kluwer. Retrieved August 11, 2020, from https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/117633/all/Depression__Treatment_Resistant
Depression, Treatment Resistant [Internet]. In: Stephens MB, Golding J, Baldor RA, Domino FJ, editors. 5-Minute Clinical Consult. Wolters Kluwer; 2020. [cited 2020 August 11]. Available from: https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/117633/all/Depression__Treatment_Resistant.
* Article titles in AMA citation format should be in sentence-case
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T1 - Depression, Treatment Resistant
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ED - Golding,Jeremy,
ED - Baldor,Robert A,
ED - Domino,Frank J,
BT - 5-Minute Clinical Consult, Updating
UR - https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/117633/all/Depression__Treatment_Resistant
PB - Wolters Kluwer
ET - 27
DB - Medicine Central
DP - Unbound Medicine
ER -
