Treatment-Resistant Depression E-Book

• Herausgeber: John Wiley & Sons
• Kategorie: Fachliteratur
• Sprache: Englisch

Seitenzahl: 291

Veröffentlichungsjahr: 2013

Beschreibung

Treatment-resistant Depress

Successful management of patients with treatment-resistant depression requires a thorough understanding of the biological basis for both the depression and its failure to respond to standard treatments. This book clearly and succinctly summarizes the latest scientific research and its applications in clinical practice.

A first step is a clear definition of what constitutes treatment-resistant depression so that clinical trials and other studies are using common criteria, enabling comparison and meta-analysis of their outcomes. The opening chapter reviews definitions and predictors of treatment-resistant depression originating from different fields and discusses their usefulness in clinical practice and clinical research. The next chapter proposes a new definition, adapting terminology from medicine.

Biological classification requires identification of genetic risk factors and gene variants have been identified as accounting for 50% of the variance in the clinical outcomes of antidepressant treatments. Chapter 3 describes several genes already associated with treatment-resistant depression and, while further work is needed to translate findings into clinical recommendations, suggests that genetic prediction of treatment resistance could become a widespread clinical reality within a few years.

Most patients with treatment-resistant depression will be treated pharmacologically, so three chapters review the latest evidence for pharmacological best practice in switching strategies for antidepressants, the role of antipsychotics and augmentation strategies to complement lithium.

There are two major alternatives to pharmacotherapy: neuromodulation and psychotherapy. The brain intervention chapter summarizes clinical research and experience with electroconvulsive therapy, transcranial magnetic stimulation, vagus nerve stimulation, deep brain stimulation and magnetic seizure therapy. The final chapter reviews the literature pertaining to the effectiveness of various forms of psychotherapy in patients who have not responded to antidepressant pharmacotherapy, explaining that patients who have not responded to one or two trials of antidepressant medication have a 30%-50% chance of responding to a focused psychotherapy. It proposes indications for psychotherapy in treatment-resistant depression and summarizes general therapeutic principles.

Essential reading for all psychiatrists managing patients with this distressing disorder.

Leseprobe

Contents

List of Contributors

Foreword

CHAPTER 1: Definitions and Predictors of Treatment-resistant Depression

Summary

Introduction

Definition of TRD: historical perspective

TRD staging models

Definition of TRD in clinical trials

Clinical characteristics and predictors of TRD

Conclusions

CHAPTER 2: Treatment-resistant Depression: A Separate Disorder – A New Approach

Summary

Introduction

Historical background

Current TRD concepts and their limitations

Towards a new definition and nosology

Towards a new terminology: malignant, pernicious or virulent depression

CHAPTER 3: Genetics of Treatment-resistant Depression

Summary

Introduction

Genetic polymorphisms and antidepressant efficacy

Conclusions

CHAPTER 4: Is There a Role for Switching Antidepressants in Treatment-resistant Depression?

Summary

Introduction

Raising the dose

Switching antidepressant pharmacological class

Guidelines on second-step treatment of nonresponders

Does switching class of antidepressant improve response?

Conclusions

CHAPTER 5: The Role of Atypical Antipsychotics in Inadequate-response and Treatment-resistant Depression

Summary

Introduction

Epidemiology: prescription data

Efficacy of SGAs in TRD

Side effects

Conclusions

CHAPTER 6: Lithium, Thyroid Hormones and Further Augmentation Strategies in Treatment-resistant Depression

Summary

Introduction

Augmentation studies

Combined treatment with antidepressants from the beginning: acceleration studies

Conclusions

CHAPTER 7: The Role of Nonpharmacological Interventions in Treatment-resistant Depression

Summary

Introduction

Electroconvulsive therapy

Repetitive transcranial magnetic stimulation

Vagus nerve stimulation

Deep-brain stimulation

Magnetic seizure therapy

CHAPTER 8: The Role of Psychotherapy in the Management of Treatment-resistant Depression

Summary

Introduction

Natural history of depression

Depression-focused psychotherapy

Evidence that psychotherapy is as effective as pharmacotherapy

Studies of TRD

Assessing patients for psychotherapy

Identifying goals for therapy

Conclusions

Index

This edition first published 2013, © 2013 by John Wiley & Sons, Ltd

Wiley-Blackwell is an imprint of John Wiley & Sons, formed by the merger of Wiley’s global Scientific, Technical and Medical business with Blackwell Publishing.

Registered OfficeJohn Wiley & Sons, Ltd, The Atrium, Southern Gate, Chichester, West Sussex, PO19 8SQ, UK

Editorial Offices9600 Garsington Road, Oxford, OX4 2DQ, UKThe Atrium, Southern Gate, Chichester, West Sussex, PO19 8SQ, UK2121 State Avenue, Ames, Iowa 50014-8300, USA

For details of our global editorial offices, for customer services and for information about how to apply for permission to reuse the copyright material in this book please see our website at www.wiley.com/wiley-blackwell.

The right of the author to be identified as the author of this work has been asserted in accordance with the UK Copyright, Designs and Patents Act 1988.

All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted, in any form or by any means, electronic, mechanical, photocopying, recording or otherwise, except as permitted by the UK Copyright, Designs and Patents Act 1988, without the prior permission of the publisher.

Designations used by companies to distinguish their products are often claimed as trademarks. All brand names and product names used in this book are trade names, service marks, trademarks or registered trademarks of their respective owners. The publisher is not associated with any product or vendor mentioned in this book.

Limit of Liability/Disclaimer of Warranty: While the publisher and author(s) have used their best efforts in preparing this book, they make no representations or warranties with respect to the accuracy or completeness of the contents of this book and specifically disclaim any implied warranties of merchantability or fitness for a particular purpose. It is sold on the understanding that the publisher is not engaged in rendering professional services and neither the publisher nor the author shall be liable for damages arising herefrom. If professional advice or other expert assistance is required, the services of a competent professional should be sought.

Library of Congress Cataloging-in-Publication Data

Treatment-resistant depression / [edited by] Siegfried Kasper, Stuart Montgomery. p. ; cm. Includes bibliographical references and index.

ISBN 978-1-119-95290-9 (pbk.)I. Kasper, S. (Siegfried) II. Montgomery, S. A.[DNLM: 1. Depressive Disorder, Treatment-Resistant–therapy. 2. Antidepressive Agents–therapeutic use. 3. Psychotherapy. WM 171.5]616.85′2706–dc23

2012043215

A catalogue record for this book is available from the British Library.

Wiley also publishes its books in a variety of electronic formats. Some content that appears in print may not be available in electronic books.

Cover image: © Mike Kiev, iStockphoto.com.Cover design by Sarah Dickinson.

List of Contributors

Dr. Elena Akimova, MD Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria

Prof. Michael Bauer, MD, PhD Professor and Chair of Psychiatry, Department of Psychiatry and Psychotherapy, University Hospital Carl Gustav Carus, Dresden University of Technology, Dresden, Germany

Dr. Chiara Fabbri, MD Department of Biomedical and NeuroMotor Sciences, University of Bologna, Bologna, Italy

Dr. Ramesh K. Gupta, MD Consultation and Liaison Psychiatry Unit, The Canberra Hospital, Canberra, Australia

Dr. Robert Haußmann, MD Department of Psychiatry and Psychotherapy, University Hospital Carl Gustav Carus, Dresden University of Technology, Dresden, Germany

Prof. Siegfried Kasper, MD Professor and Chair, Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria

Dr. Sarah Kayser, MD, MSc Department of Psychiatry and Psychotherapy, University Hospital Bonn, Bonn, Germany

Prof. Hans-Jürgen Möller, MD Professor Emeritus and former Chair of Psychiatry, Department of Psychiatry and Psychotherapy, Ludwig Maximilians University, Munich, Germany

Prof. Stuart Montgomery, MD Emeritus Professor of Psychiatry, Professor of Psychiatry (retired), Imperial College of Science, Technology and Medicine, University of London, London, UK

Prof. William Pitchot, MD, PhD Department of Psychiatry, University of Liège, Liège, Belgium

Dr. Stefano Porcelli, MD Department of Biomedical and NeuroMotor Sciences, University of Bologna, Bologna, Italy

Dr. Rebecca Schennach, MD Department of Psychiatry and Psychotherapy, Ludwig Maximilians University, Munich, Germany

Prof. Thomas E. Schläpfer, MD Vice Chair and Professor of Psychiatry and Psychotherapy, Department of Psychiatry and Psychotherapy, University Hospital Bonn, Bonn, Germany; Associate Professor of Psychiatry and Mental Health, The Johns Hopkins University School of Medicine, Maryland, USA

Dr. Florian Seemüller, MD Department of Psychiatry and Psychotherapy, Ludwig Maximilians University, Munich, Germany

Prof. Alessandro Serretti, MD, PhD Department of Biomedical and NeuroMotor Sciences, University of Bologna, Bologna, Italy

Prof. Daniel Souery, MD Director at Psy Pluriel, European Centre of Psychological Medicine – PsyPluriel, Brussels, Belgium

Prof. Michael E. Thase, MD Professor Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia Veterans Affairs Medical Center, PA, USA; Adjunct Professor of Psychiatry, University of Pittsburgh Medical Center, PA, USA

Foreword

Clinical depression is both a symptom and a debilitating ­disorder. The World Bank estimates that, by 2020, depression will become the most common noncommunicable disease in the world, with the heaviest burden of disease. Depression ­carries with it stigma, and the disease is misunderstood as a lack of will power. The proven strategies for treating depression include both pharmacotherapy and psychotherapy, as well as a mixture of the two.

Treatment-resistant depression remains relatively common and the reasons for this vary from missing diagnoses to inadequate therapeutic interventions. Definitions of treatment-resistant depression also vary. Treatment-resistant depression can be a staging process, which can enable clinicians to intervene appropriately and adequately, so that the burden of the disease is reduced and quality of life for the patient and their carers can be improved. Investigations for staging models must include both biological and nonbiological factors. In addition, cultural variations must be taken into account. Psychotherapy alone or in combination with pharmacotherapy is part of the therapeutic armamentarium.

The editors, both eminent psychiatrists in the field, with international reputations, have brought together a star-studded cast to explain not only the staging process but interventions too, making this volume of great interest and much use for ­clinicians in their clinical practice. For this alone, the editors deserve our congratulations and thanks.

Dinesh Bhugra CBEProfessor of Mental Health & Cultural DiversityInstitute of Psychiatry, King’s College LondonPresident-Elect, World Psychiatric Association

CHAPTER 1

Definitions and Predictors of Treatment-resistant Depression

Daniel Souery

European Centre of Psychological Medicine – PsyPluriel, Brussels, Belgium

William Pitchot

Department of Psychiatry, University of Liège,Liège, Belgium

Summary

Treatment-resistant depression (TRD) remains a common ­condition, with 50–60% of patients not achieving meaningful response following antidepressant treatment. The huge complexity of the phenomenon and the wide variety of parameters that must be taken into account make creating a definition ­possible, but several attempts have been proposed over the last 30 years. Many TRD staging models have been suggested, all of them intended to clarify the concept of TRD, but the lack of consensus represents an ongoing clinical and nosological controversy. In parallel, efforts towards a more accurate definition are aimed at proposing clear-cut criteria for clinical trials and research to evaluate specific treatment strategies and biological factors in TRD.

Beyond a definition, efforts have been made to identify key clinical factors associated with TRD.

The purpose of this chapter is to review current available definitions and predictors of TRD originating from different fields and to discuss their usefulness in clinical practice and clinical research.

Introduction

Although TRD appears to be relatively common in clinical practice, the inconsistent way in which it has been characterized and defined remains a real problem, limiting systematic research. From a clinical point of view, TRD usually refers to an inadequate response to at least one antidepressant trial of adequate dose and duration. It is estimated that 50–60% of patients do not achieve meaningful response following antidepressant treatment (Souery ., 1999). This conception may include a variety of clinical ­situations, from uncomplicated failure to one course of ­antidepressant to multiple failures with long-term persistence of depressive symptoms despite more complex treatments. The term is ­generally used in these ­circumstances. While this approach corresponds to the clinical reality, it doesn’t help to define TRD and to predict which depressive episode will be resistant to treatment. The huge complexity of the phenomenon and the wide variety of p­arameters that must be taken into account make creating a definition possible, but several attempts have been proposed over the last 30 years. Misdiagnosis (‘pseudoresistance’), comorbidities, definition of treatment response, treatment duration and ­compliance and the number of treatment failures are among the more difficult variables which need to be integrated in any attempt to characterize or define TRD, making this a real ­challenge (Fornaro ., 2010).