Skip to main content


Showing posts with the label Refractory Depression

Pharmacological Treatment Algorithm for Treatment Refractory Depression

Pharmacological Treatment Algorithm for Treatment-Refractory Depression These recommendations are based on the Maudsley Prescribing Guidelines 2018, according to which, depression is treatment refractory when it does not respond to sequential trials of three different antidepressants as recommended in their algorithms.  In the first three steps below, we have enlisted the recommended pharmacological treatment options for an episode of depression. subsequently, we list the options for treatment-refractory depression. Maudsley Prescribing Guidelines focus on the pharmacological treatment options and algorithms, never nevertheless, they acknowledge the important role of non-pharmacological interventions in its treatment and recommend considering one of the appropriate options like cognitive behaviour therapy and/or behavioural activation and other factors identified as being responsible for resistance. Step 1: Recommend an SSRI or mirtazapine. monitor for signs and effects for 3- to 4 w

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

Clinical Vignette: Management of a Patient with Treatment-Refractory Depression

Clinical Vignette: Management of a Patient with Treatment-Refractory Depression Mr X is a known case of depressive illness for the last 1 year. He has stopped responding after two different groups of antidepressants were tried and has been labelled as a patient of treatment-resistant depression.  How will you assess the cause of this resistance? Write the treatment algorithm that you will follow for his management? If you had to start lithium in this case, what protocol would you follow to start it and how will you monitor it? Treatment Options for Refractory Depression