ABSTRACT
AIMS: This work would give an overall vision of the actual knowledge about nosography and clinic of treatment-resistant depression. METHOD: A PubMed, PsychInfo, Google Scolar search was done using the key words "resistant depression", "STAR*D", "bipolar depression", "staging". Have been selected exclusively works in English, French and Italian languages. RESULTS: Treatment-resistant depression is one of the most important problem in public health. Nevertheless a general consensus about its definition and staging does not exist at now. Principal risk factors and associated comorbidities are well known including the association with bipolar spectrum; anyway the disease particularly common among depressed outpatients is still very disabling, responsible of an often chronic course, with numerous relapses and high risk of suicide. DISCUSSION AND CONCLUSION: The future investigations, once improved procedures for differential diagnosis and subtyping of clinical depression, should be directed to the search of a shared definition of treatment resistance and the development of specific therapeutic protocols.
Subject(s)
Depressive Disorder, Treatment-Resistant , Antidepressive Agents/administration & dosage , Antidepressive Agents/classification , Antidepressive Agents/pharmacokinetics , Antidepressive Agents/therapeutic use , Anxiety Disorders/epidemiology , Biotransformation/genetics , Bipolar Disorder/epidemiology , Bipolar Disorder/psychology , Comorbidity , Depressive Disorder, Treatment-Resistant/classification , Depressive Disorder, Treatment-Resistant/diagnosis , Depressive Disorder, Treatment-Resistant/epidemiology , Depressive Disorder, Treatment-Resistant/therapy , Diagnosis, Differential , Drug Substitution , Electroconvulsive Therapy , Endocrine System Diseases/diagnosis , Endocrine System Diseases/psychology , Genetic Predisposition to Disease , Humans , Models, Psychological , Panic Disorder/epidemiology , Psychotherapy , Recurrence , Risk Factors , Severity of Illness Index , Treatment Failure , Suicide PreventionABSTRACT
Aim. To confirm the efficacy and tolerability of ziprasidone as adjunctive therapy in bipolar patients partially responding to clozapine or with persisting negative symptoms, overweight, or with metabolic syndrome. Methods. Eight patients with psychotic bipolar disorder were tested with the BPRS, the HAM-D, and the CGI at T0 and retested after 2 weeks (T1). Plasma clozapine and norclozapine levels and BMI were tested at T0 and T1. Results. Ziprasidone was well tolerated by all the patients. BPRS and HAM-D scores were reduced in all patients. BMI was reduced in patients with a BMI at T0 higher than 25. Plasma levels of clozapine and norclozapine showed an irregular course.
ABSTRACT
AIM: This work would give an overall and up-to-date vision of psychopharmacological and physical strategies of treatment for resistant depression. METHOD: A PubMed search was done using the keywords "resistant depression treatment", "electroconvulsive therapy", "antidepressants", and the inclusion criteria of adult samples, English, French or Italian languages. RESULTS: Lots of psycho-pharmacological and physical treatment strategies for resistant depression exist; anyway there is no consensus about their indications and efficacy, which appears still unsatisfactory. DISCUSSION AND CONCLUSION: Further research should move towards the identification of specific clinical picture of treatment resistant depression to develop more efficacious and selective treatment protocols.
