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Showing posts with the label Refractory Depression

Treatment Options for Refractory Depression

Treatment of Refractory Depression When depression does not improve with three sequential trials of antidepressants, we call it treatment-refractory depression. the following is the list of choices for treatment-refractory depression.  First-line Treatment Options Bupropion 400 mg/d + SSRI Olanzapine + fluoxetine 25/50 mg/d Venlafaxine + mirtazapine 30-45 mg/d Add lithium, aim up to 1.0 mmol/L concentration.  Add aripiprazole 2-20 mg/d Add quetiapine 150-300 mg/d  Second-line Choices Ketamine-IV (0.5 mg/kg IV over 40 minutes),   à rapidly effective, by the anesthetist High-dose venlafaxine à 200 mg/d,    à NICE recommended, monitor BP Electroconvulsive therapy à effective, stigmatized Add risperidone 0.5-3 mg/d,   à weak evidence, hypotension Add Triiodothyronine 20–50 μ g/d, à reasonable evidence, monitor TFTs Lamotrigine, 100, 200, 400 mg/d, à best tolerated, risk of rash SSRI+ buspirone 60 mg/d, à research-supported, dizzi