Dextroamphetamine-Amphetamine Augmentation in the Treatment of Treatment-Resistant Depression.

There is much debate over a precise definition of treatment-resistant depression (TRD) as well as the method of staging this illness. Although there is some non-consensus on a definition for TRD, the most widely accepted definition of TRD is a failure to achieve clinical improvement of depressive symptoms following a trial of two or more antidepressant medications from two or more different pharmacological classes at adequate dosage, duration, and compliance. Some sources lower the threshold to failure of one medication, but most support two medications. Although both men and women can be effected by TRD, our review found a slight predominance in older women. Here we present a 62-year-old female diagnosed with severe major depressive disorder that meets the criteria for treatment-resistant depression. This patient failed to experience consistent relief of symptoms using different antidepressant monotherapies as well as different combinations of therapies. Transcranial magnetic stimulation provided a brief relief of symptoms in this patient; however, relapse occurred a few months later. This case is unique as this patient has recently experienced significant relief of her depressive symptoms using amphetamine and dextroamphetamine (Adderall) as an adjunct to her antidepressant therapy. We will review the literature that currently exists on treatment-resistant depression and the treatment options for TRD, as well as present our case. To our knowledge, a case of TRD responding so strongly to Adderall after failing to respond to such drastic pharmacologic measures, as well as TMS, has not been reported.

The impact of a psychosocial program on clinical outcomes for severe psychiatric disorders.

BACKGROUND: This retrospective study evaluated the impact of a psychosocial program on individuals with severe and chronic psychiatric disorders. This study also examined potential modifiable predictors of hospitalization. METHODS: The sample was comprised of 94 individuals with severe and chronic mental illness who were followed in the Community Support Network (CSN), a psychosocial program. Data from initial assessment at admission to the CSN were compared with the last assessment after admission, during data abstraction. Data were analyzed using analysis of variance for hospitalization, accommodation (housing), and employment, and the logistic regression procedure was used to analyze the relationship among potential modifiable clinical independent variables and hospitalization. RESULTS: Admission to CSN significantly reduced hospitalization rates. Presence of psychotic symptoms increased the likelihood of hospitalization, and the use of support groups, antidepressants, and mood stabilizers decreased the risk for hospitalization. CONCLUSIONS: Our findings suggest that CSN reduced hospitalization rates as well as increased employment, and the switch from the Assertive Community Treatment program to the Community Support Team program in 2007 did not change this effect. The overall significant reduction in psychiatric symptoms could explain these positive findings.