Health
Treatment-Resistant Depression Affects Millions of Americans Each Year
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Jun 21, 2008, 19:52

(NAPSI)-Millions of Americans with depression are able to successfully manage their condition with a combination of available therapies.

However, according to an article in the Journal of Clinical Psychiatry, up to 35 percent of patients treated for depression may have a little-known condition called Treatment-Resistant Depression, or TRD.

“There are evolving definitions of TRD among the research community, but at this point, a TRD diagnosis is usually given to a patient with major depressive disorder who has failed two adequate trials of an antidepressant medication,” said Dr. W. Clay Jackson, a primary care physician and assistant professor of clinical psychiatry at the University of Tennessee.

Depression Is a Highly Debilitating Disease

Not being able to find an effective treatment is a serious challenge for those who suffer from depression.

There are many types of depression that can be difficult to treat, including major depressive disorder (MDD), bipolar depression and psychotic depression.

MDD, the most common form of depression, is a highly debilitating disease. A 2007 article in The Lancet points out that the World Health Organization has concluded that it is the single most disabling medical condition.


Furthermore, depression that is hard to treat is often more severe, more chronic and more disabling. In addition, treatment resistance increases the likelihood of physical symptoms in patients such as aches, pains, headache or GI disturbance.

TRD patients are also more likely to have attempted suicide at some point in their lives, says an article in the Journal of Psychiatric Research, as well as an article in the Journal of Clinical Psychiatry.

In November 2006, the National Institute of Mental Health published the results of a study designed to evaluate depression treatments.

The Sequenced Treatment Alternatives to Relieve Depression (STAR*D) trial was conducted over seven years and enrolled over 4,000 patients, states a report from the American Journal of Psychiatry.

“The main message from the STAR*D trial, the largest trial to date to look at various pharmacological treatments for resistant patients, was that after each successive treatment failure, recovery is less likely,” said Jackson. “The longer a patient has a depressive episode or the more severe the depression, the less likely remission will occur.”

Dr. Jackson explained that the decreasing likelihood of recovery may result from neurological changes, including reduction of brain volume and function, as a result of depression.

Treatment Options Do Exist

Unfortunately, it often takes some time to find the right medication or nonmedical therapy. For the millions of people who suffer from TRD, other treatment options do exist.

Augmenting or supplementing an antidepressant with another psychotropic medication (not originally intended to treat depression) can help some patients.

Other options include cytochrome P450 genotyping testing (which checks for specific genes that affect how a person’s body uses antidepressants), combining different classes of antidepressants (such as a selective serotonin reuptake inhibitor with a norepinephrine and dopamine reuptake inhibitor), increasing the dosage of a medication or trying a medication for a longer period.

Patients may also benefit from psychotherapy, exercise or somatic interventions.

“TRD is far more common than most people realize,” said Jackson. “Patients suffering from chronic depression may possibly have TRD and should seek help from their clinician.”

“There are evolving definitions of TRD among the research community, but at this point, a TRD diagnosis is usually given to a patient with major depressive disorder who has failed two adequate trials of an antidepressant medication.”

-Dr. W. Clay Jackson

Note: The following attributions relate to the references cited in the feature copy above.

Nemeroff, CB. Prevalence and management of treatment-resistant depression. J Clin Psych. 2007;68 (suppl 8): 17-25.

Moussavi S, et al. Depression, chronic diseases, and decrements in health: results from the World Health Surveys. Lancet 2007;370:871-58.

Nelsen MR, Dunner DL. Clinical and differential diagnostic aspects of treatment-resistant depression. J Psychiatr Res. 1995;29:43-50.

Greden, JF. The Burden of Recurrent Depression: Causes, Consequences, and Future Prospects. J Clin Psych. 2001;62 (suppl 22): 5-9

Rush et al. Acute and Longer-Term Outcomes in Depressed Outpatients Requiring One or Several Treatment Steps: A STAR*D Report Am J Psych 2006;163:1905-1917.

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