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1.
Epidemiol Psychiatr Sci ; 29: e79, 2019 Dec 16.
Artigo em Inglês | MEDLINE | ID: mdl-31841104

RESUMO

In March 2019, the US Food and Drug Administration (FDA) approved a nasal spray formulation of esketamine for the treatment of resistant depression in adults. Esketamine is the S-enantiomer of ketamine, an FDA-approved anaesthetic, known to cause dissociation and, occasionally, hallucinations. While ketamine has not been approved for depression in the USA or in any other country, it has been used off-label in cases of severe depression. This commentary critically reviewed the evidence on esketamine submitted to the FDA, aiming to draw implications for clinical practice, research and regulatory science.


Assuntos
Antidepressivos/uso terapêutico , Depressão/tratamento farmacológico , Transtorno Depressivo Resistente a Tratamento/tratamento farmacológico , Ketamina/uso terapêutico , Adulto , Antidepressivos/administração & dosagem , Depressão/diagnóstico , Transtorno Depressivo Resistente a Tratamento/diagnóstico , Aprovação de Drogas , Medicina Baseada em Evidências , Humanos , Infusões Intravenosas , Ketamina/administração & dosagem , Estados Unidos , United States Food and Drug Administration
2.
Rev Assoc Med Bras (1992) ; 65(3): 361-369, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30994834

RESUMO

BACKGROUND: There is no strong evidence on the link between inflammatory profile and pattern of drug treatment response in depressive patients that could result in Coronary Artery Disease occurrence. OBJECTIVE: This study aimed to compare the subclinical atherosclerosis markers, inflammatory profile, and BDNF production in Resistant Depression (RD) or Bipolar Affective Disorder (BAD) patients under conventional treatment. METHODS: The population evaluated was comprised of 34 RD, 43 BAD, and 41 controls. Subclinical atherosclerosis markers were evaluated using ultrasonography, tomography, and exercise stress test. Plasma concentrations of TNFα, IL-1ß, IL-6, and BDNF were measured using Luminex100™. The usCRP concentration was measured using turbidimetric immunoassay. IL1B, IL6, and TNFA expression were determined using TaqMan®. For the statistical analysis, the significance level was established at p<0.05. RESULTS: Concerning subclinical atherosclerosis markers, only O2 consumption was reduced in the BAD group (p = 0.001). Although no differences were found in gene expression, BDNF and IL-1ß plasma concentration was increased in the RD group (p = 0.002 and p = 0.005, respectively) even with an antidepressant treatment, which suggests that these drugs have no effect in IL-1ß secretion and that the inflammasome may play a role in therapy response. CONCLUSION: Taken together, both BDNF and IL-1ß plasma concentrations could be used to the early identification of RD patients.


Assuntos
Transtorno Bipolar/sangue , Fator Neurotrófico Derivado do Encéfalo/sangue , Transtorno Depressivo Resistente a Tratamento/sangue , Interleucina-1beta/sangue , Adulto , Anti-Inflamatórios/uso terapêutico , Antidepressivos/uso terapêutico , Aterosclerose/sangue , Biomarcadores/sangue , Transtorno Bipolar/diagnóstico , Transtorno Bipolar/tratamento farmacológico , Índice de Massa Corporal , Transtorno Depressivo Resistente a Tratamento/diagnóstico , Transtorno Depressivo Resistente a Tratamento/tratamento farmacológico , Feminino , Humanos , Interleucina-6/sangue , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Reação em Cadeia da Polimerase em Tempo Real , Valores de Referência , Estatísticas não Paramétricas , Fator de Necrose Tumoral alfa/sangue
4.
Rev. andal. med. deporte ; 12(1): 50-52, ene.-mar. 2019. tab
Artigo em Espanhol | IBECS | ID: ibc-184496

RESUMO

Se presenta un estudio de caso de un deportista de elite que desarrolló una psicopatología sobrevenida, que interfería en su carrera atlética. Tras ganar dos medallas en una competición internacional, entró en un estado de ansiedad, depresión, nerviosismo y apatía y dejó de entrenar durante cinco meses. Durante este tiempo no atendió al sistema ADAMS, y fue citado por el Control Antidopaje de la WADA para que se defendiera. Fue diagnosticado de un Trastorno Depresivo Mayor Recidivante (269.3x, DSM-IV-TR, 2002) con un GAP entre 45 y 50, y un Síndrome de Burnout. La intervención duró cinco meses con una sesión semanal basada en Psicoterapia Psicodinámica Breve, Enseñanza de estrategias adaptativas de afrontamiento y Apoyo social. Tras oír las alegaciones del psicólogo, por consenso, le permitieron volver a competir


This paper presents a case study in which an elite athlete developed a sports-associated psychopathology, interfering with his athletic career. After receiving medals in a top competition, the subject entered into an unusual state of anxiety, depression, nervousness, and apathy and he completely stopped his training for five months. During this time, he neglected ADAMS system controls, and was quoted by WADA to make legal arguments in his defense. He was diagnosed, with Relapsing Serious Depressive Disorder (269.3x, DSM-IV-TR, 2002) and a GAF between 45 and 50, and a Burnout Syndrome. An intervention was implemented over a five month period in the form of weekly sessions. It was based on Short-Term Psychodynamic Psychotherapy (ISTDP); Teaching effective use of well-adapted coping strategies and Social support. After hearing Sport Psychologist allegations by consensus, allowing him to compete


Apresenta-se um estudo de caso de um atleta de elite que desenvolveu uma psicopatologia que interferia com a sua carreira desportiva. Depois de ganhar duas medalhas numa competição internacional, entrou num estado de ansiedade, depressão e apatia, interrompendo os treinos durante cinco meses. Ao longo desse tempo não compareceu ao sistema ADAMS e foi convocado pelo Controle Anti-Doping da WADA para alegações de defesa. Foi-lhe diagnosticado um transtorno depressivo recorrente major (269,3x, DSM-IV-TR, 2002) com um GAP entre 45 e 50 e um Síndrome de Burnout. A intervenção durou cinco meses com uma sessão semanal baseada na psicoterapia psicodinâmica breve, ensino de estratégias de coping e suporte social. Na sequência das alegações do psicólogo, por consenso, foi-lhe permitido que voltasse a competir


Assuntos
Humanos , Masculino , Adulto Jovem , Transtorno Depressivo Resistente a Tratamento/terapia , Psicoterapia Psicodinâmica/métodos , Esgotamento Profissional/terapia , Atletas/psicologia , Transtorno Depressivo Resistente a Tratamento/diagnóstico , Esgotamento Profissional/diagnóstico , Adaptação Psicológica , Apoio Social , Doping nos Esportes/psicologia
5.
J Stroke Cerebrovasc Dis ; 28(5): 1252-1260, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30770255

RESUMO

INTRODUCTION: To test the hypotheses that changes in the aortic pulse-wave produced by arterial stiffening are (1) propagated into cerebral small vessels, (2) associated with reduced compliance of small cerebral arterial vessels, and (3) associated with the presence of dilated perivascular spaces (PVS). METHODS: Fifteen volunteers and 19 patients with late-onset depression (LOD) were prospectively recruited, of which 6 fulfilled the criteria for treatment-resistant depression (TRD). Aortic pulse-wave velocity (PWV) was determined using Carotid-Femoral Doppler. Pulse-wave analysis (PWA) was performed using a SphygmoCor system. White-matter lesion load and PVS were scored on established MRI scales. Cerebral arterial and aqueductal cerebrospinal fluid (CSF) flow patterns were studied using quantitative phase-contrast angiography. RESULTS: Depressed patients had more PVS (P < .05) and prolongation of the width of the arterial systolic pulse-wave in the carotid arteries (P < .01). There was no significant group difference for any PWV or PWA measurement. TRD patients showed more PVS than other LOD patients (P < .05). The fractional width of the arterial systolic peak correlated significantly with augmentation index (AIx) and heart rate-corrected augmentation index (AIx75; R2 = 0.302, P < .01and R2 = 0.363, P < .01 respectively). Arterial-aqueductal delay showed a negative correlation with estimated aortic systolic pressure (PWVsys; R2 =  0.293; P < .01), AIx (R2 = -0.491; P < .01) and AIx75 (R2 = -0.310; P < .01). PVS scores correlated with AIx (R2 = 0.485; P < .01) and AIx75 (R2 = -0.292; P < .01). CONCLUSION: Our findings support the hypothesis that increased arterial pulsatility resulting from central arterial stiffness propagates directly into cerebral vessels and is associated with the development of microvascular angiopathy, characterized by dilated PVS and decreased compliance of small arterial vessels.


Assuntos
Aorta/fisiopatologia , Artérias Cerebrais/fisiopatologia , Transtornos Cerebrovasculares/fisiopatologia , Transtorno Depressivo Resistente a Tratamento/fisiopatologia , Fluxo Pulsátil , Rigidez Vascular , Idoso , Angiografia Cerebral/métodos , Transtornos Cerebrovasculares/diagnóstico , Transtorno Depressivo Resistente a Tratamento/diagnóstico , Feminino , Humanos , Angiografia por Ressonância Magnética , Masculino , Estudos Prospectivos , Análise de Onda de Pulso , Ultrassonografia Doppler
6.
Tijdschr Psychiatr ; 61(2): 104-111, 2019.
Artigo em Holandês | MEDLINE | ID: mdl-30793271

RESUMO

BACKGROUND: Studies have indicated an association between treatment refractoriness in unipolar depression and unrecognised bipolar spectrum disorder (bsd). If confirmed, this may have implications for diagnosis and treatment.
AIM: To provide an overview on the prevalence and recognition of bsd in treatment resistant depression (trd).
METHOD: A search was made in PubMed concerning the prevalence of bsd in trd and clinical features that may be suggestive of bipolar depression.
RESULTS: Three articles were found that examined the prevalence of bsd in trd; they reported that 26-47% of patients with trd had an underlying bsd. Five cross-sectional studies described the predictors of clinical features in patients with a major depression. The following features occurred significantly more often: positive family history of bsd, young age of onset, higher number of recurrences, and atypical features.
CONCLUSION: There seems to be an association between trd and having an underlying bsd. A few clinical features may help to detect bsd in trd.


Assuntos
Transtorno Bipolar/epidemiologia , Transtorno Depressivo Resistente a Tratamento/epidemiologia , Transtorno Bipolar/diagnóstico , Transtorno Depressivo Resistente a Tratamento/diagnóstico , Humanos , Prevalência , Fatores de Risco
7.
Psychiatry Res ; 273: 567-574, 2019 03.
Artigo em Inglês | MEDLINE | ID: mdl-30711853

RESUMO

In major depressive disorder (MDD) patients, life stress events represent a risk factor for a severe, early-onset, treatment-resistant and chronic endophenotype. Treatment-resistant depression (TRD) patients who have experienced traumatic events could benefit from evidence-based trauma-focused psychotherapies. Because this topic has never been investigated, the aim of this pilot trial was to evaluate whether trauma-focused cognitive-behavioural therapy (TF-CBT) and/or eye movement desensitization and reprocessing (EMDR) can help achieve depressive symptom remission in TRD patients. We carried out a single-blind randomized controlled trial with TRD patients and we compared EMDR (N = 12) with TF-CBT (N = 10). Patients received 3 individual sessions per week over a period of 8 weeks. The symptomatological assessments were performed at 4 timepoints: baseline (T0), 4 (T4), 8 (T8) and 12 (T12) weeks. After 24 weeks, a clinical interview was carried out by phone. All TRD patients showed a significant improvement in depressive symptomatology; however, post hoc comparisons showed a significant difference between the two treatment groups, with lower depressive symptom scores in the EMDR than in the TF-CBT group at the follow-up (T12). This effect was partly maintained at 24 weeks. This pilot study suggests that evidence-based trauma-focused psychotherapies, particularly EMDR, can represent effective interventions to treat TRD patients.


Assuntos
Terapia Cognitivo-Comportamental/métodos , Transtorno Depressivo Maior/terapia , Transtorno Depressivo Resistente a Tratamento/terapia , Dessensibilização e Reprocessamento através dos Movimentos Oculares/métodos , Transtornos de Estresse Pós-Traumáticos/terapia , Adolescente , Adulto , Transtorno Depressivo Maior/diagnóstico , Transtorno Depressivo Maior/psicologia , Transtorno Depressivo Resistente a Tratamento/diagnóstico , Transtorno Depressivo Resistente a Tratamento/psicologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Projetos Piloto , Psicoterapia/métodos , Método Simples-Cego , Transtornos de Estresse Pós-Traumáticos/diagnóstico , Transtornos de Estresse Pós-Traumáticos/psicologia , Resultado do Tratamento
8.
Br J Psychiatry ; 214(1): 11-19, 2019 01.
Artigo em Inglês | MEDLINE | ID: mdl-29764522

RESUMO

BACKGROUND: C-reactive protein (CRP) is a candidate biomarker for major depressive disorder (MDD), but it is unclear how peripheral CRP levels relate to the heterogeneous clinical phenotypes of the disorder.AimTo explore CRP in MDD and its phenotypic associations. METHOD: We recruited 102 treatment-resistant patients with MDD currently experiencing depression, 48 treatment-responsive patients with MDD not currently experiencing depression, 48 patients with depression who were not receiving medication and 54 healthy volunteers. High-sensitivity CRP in peripheral venous blood, body mass index (BMI) and questionnaire assessments of depression, anxiety and childhood trauma were measured. Group differences in CRP were estimated, and partial least squares (PLS) analysis explored the relationships between CRP and specific clinical phenotypes. RESULTS: Compared with healthy volunteers, BMI-corrected CRP was significantly elevated in the treatment-resistant group (P = 0.007; Cohen's d = 0.47); but not significantly so in the treatment-responsive (d = 0.29) and untreated (d = 0.18) groups. PLS yielded an optimal two-factor solution that accounted for 34.7% of variation in clinical measures and for 36.0% of variation in CRP. Clinical phenotypes most strongly associated with CRP and heavily weighted on the first PLS component were vegetative depressive symptoms, BMI, state anxiety and feeling unloved as a child or wishing for a different childhood. CONCLUSIONS: CRP was elevated in patients with MDD, and more so in treatment-resistant patients. Other phenotypes associated with elevated CRP included childhood adversity and specific depressive and anxious symptoms. We suggest that patients with MDD stratified for proinflammatory biomarkers, like CRP, have a distinctive clinical profile that might be responsive to second-line treatment with anti-inflammatory drugs.Declaration of interestS.R.C. consults for Cambridge Cognition and Shire; and his input in this project was funded by a Wellcome Trust Clinical Fellowship (110049/Z/15/Z). E.T.B. is employed half time by the University of Cambridge and half time by GlaxoSmithKline; he holds stock in GlaxoSmithKline. In the past 3 years, P.J.C. has served on an advisory board for Lundbeck. N.A.H. consults for GlaxoSmithKline. P.d.B., D.N.C.J. and W.C.D. are employees of Janssen Research & Development, LLC., of Johnson & Johnson, and hold stock in Johnson & Johnson. The other authors report no financial disclosures or potential conflicts of interest.


Assuntos
Proteína C-Reativa/análise , Transtorno Depressivo Resistente a Tratamento/diagnóstico , Adulto , Biomarcadores/sangue , Transtorno Depressivo Resistente a Tratamento/sangue , Feminino , Humanos , Masculino , Fenótipo
9.
Brain Stimul ; 12(1): 119-128, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30344109

RESUMO

BACKGROUND: The therapeutic options for treatment-resistant depression (TRD) encompass a range of neuromodulatory techniques, including repetitive transcranial magnetic stimulation (rTMS). While rTMS is safe and has documented short-term efficacy, durability of antidepressant effects is poorly established. OBJECTIVE: Assess existing evidence regarding durability of rTMS-induced antidepressant response. METHODS: We performed a systematic review of studies reporting antidepressant outcome measures collected three or more months after the end of an induction course of rTMS for depression. Among responders to the induction course, we used a meta-analytic approach to assess response rates at 3 (m3), 6 (m6) or 12 (m12) months after induction, and studied predictors of responder rates using meta-regression. RESULTS: Nineteen studies published between 2002 and 2018 were included. Eighteen were eligible for analysis at m3 (732 patients) and m6 (695 patients) and 9 at m12 (247 patients). Among initial responders, 66.5% sustained response at m3 (95% CI = 57.1-74.8%, I2 = 27.6%), 52.9% at m6 (95% CI = 40.3-65%, I2 = 0%), and 46.3% at m12 (95% CI = 32.6-60.7%, I2 = 0%), in the absence of any major bias. Random-effects meta-regressions further demonstrated that a higher proportion of women, as well as receipt of maintenance treatment, predicted higher responder rates at specific time-points. CONCLUSIONS: rTMS is a durable treatment for depression, with sustained responder rates of 50% up to 1 year after a successful induction course of treatment. Maintenance treatment may enhance the durability of the antidepressant effects of rTMS, and should be considered in clinical practice, as well as systematically explored in future clinical trials.


Assuntos
Transtorno Depressivo Resistente a Tratamento/psicologia , Transtorno Depressivo Resistente a Tratamento/terapia , Estimulação Transcraniana por Corrente Contínua/métodos , Antidepressivos/uso terapêutico , Transtorno Depressivo Resistente a Tratamento/diagnóstico , Feminino , Humanos , Estudos Prospectivos , Estudos Retrospectivos , Resultado do Tratamento
10.
J Affect Disord ; 245: 626-636, 2019 02 15.
Artigo em Inglês | MEDLINE | ID: mdl-30445388

RESUMO

BACKGROUND: The lack of uniformity in the definition of treatment resistant depression (TRD) within the Asia-Pacific (APAC) region may have implications for patient management. We aimed to characterize the most commonly used TRD definition in selected APAC countries. METHODS: A systematic literature review of TRD definitions in APAC countries was conducted in Medline and Embase (2010-2016) and conference proceedings (2014 and 2016). TRD guidelines (APAC, Europe regional, US, or international) were also searched. An expert-panel explored APAC nuances in TRD definitions to achieve consensus for a regional-level definition. RESULTS: Ten guidelines and 89 studies qualified for study inclusion. Among the studies, variations were observed in definitions regarding: number of antidepressants failed (range: ≥1 to ≥3), classes of antidepressants (same or different; 59% did not specify class), duration of previous treatments (range: 4-12 weeks), dosage adequacy, and consideration of adherence (yes/no; 88% of studies did not consider adherence). No TRD-specific guidelines were identified. The emerging consensus from the literature review and panel discussion was that TRD is most commonly defined as failure to ≥2 antidepressant therapies given at adequate doses, for 6-8 weeks during a major depressive episode. LIMITATIONS: Few studies provided definitions of TRD used in daily clinical practice, and a limited number of countries were represented in the included studies and expert panel. CONCLUSION: Attaining consensus on TRD definition may promote accurate, and possibly early detection of patients with TRD to enable appropriate intervention that may impact patient outcomes and quality of life.


Assuntos
Antidepressivos/uso terapêutico , Transtorno Depressivo Resistente a Tratamento/diagnóstico , Psicoterapia/normas , Ásia , Consenso , Transtorno Depressivo Resistente a Tratamento/tratamento farmacológico , Feminino , Humanos , Masculino , Ilhas do Pacífico , Qualidade de Vida , Falha de Tratamento
12.
Int J Neuropsychopharmacol ; 22(2): 85-92, 2019 02 01.
Artigo em Inglês | MEDLINE | ID: mdl-29961822

RESUMO

Treatment-resistant depression refers to major depressive disorder, treatment of the disorder, and failure to obtain an "acceptable" outcome. Regarding the disorder, the heterogeneous concept of major depressive disorder and the multiple definitions of treatment-resistant depression, hesitating between a categorical and a more dimensional approach, as well as the divergence between diagnostic criteria and the items in the assessment scales are a source of confusion. Classifications do not take into account the dramatic influence of patient characteristics strongly impacting outcome, although these can be the cause of so-called pseudo-resistance. Outcome is the result of spontaneous evolution, nonspecific factors (including placebo), and active treatment factors. These should be differentiated to have a reliable estimation of the impact of different treatment modalities before we can asses treatment-resistant depression or before we can ascertain the (non)efficacy of treatments for treatment-resistant depression.The impact and burden of major depressive disorder and treatment-resistant depression are immense and go far beyond their economic cost. It is often forgotten that both are not only associated with increased suicidality but also with nonsuicidal mortality and that both can even result in requests for assisted dying. The caregiver burden and associated stigma are also too often overlooked despite that it has been suggested that they do influence (treatment) outcome.


Assuntos
Efeitos Psicossociais da Doença , Transtorno Depressivo Maior , Transtorno Depressivo Resistente a Tratamento , Transtorno Depressivo Maior/classificação , Transtorno Depressivo Maior/diagnóstico , Transtorno Depressivo Maior/mortalidade , Transtorno Depressivo Maior/terapia , Transtorno Depressivo Resistente a Tratamento/classificação , Transtorno Depressivo Resistente a Tratamento/diagnóstico , Transtorno Depressivo Resistente a Tratamento/mortalidade , Transtorno Depressivo Resistente a Tratamento/terapia , Humanos
13.
J Affect Disord ; 242: 68-79, 2019 01 01.
Artigo em Inglês | MEDLINE | ID: mdl-30172227

RESUMO

BACKGROUND: Non-response to repetitive transcranial magnetic stimulation (rTMS) treatment for depression is costly for both patients and clinics. Simple and cheap methods to predict response would reduce this burden. Resting EEG measures differentiate responders from non-responders, so may have utility for response prediction. METHODS: Fifty patients with treatment resistant depression and 21 controls had resting electroencephalography (EEG) recorded at baseline (BL). Patients underwent 5-8 weeks of rTMS treatment, with EEG recordings repeated at week 1 (W1). Forty-two participants had valid BL and W1 EEG data, and 12 were responders. Responders and non-responders were compared at BL and W1 in measures of theta (4-8 Hz) and alpha (8-13 Hz) power and connectivity, frontal theta cordance and alpha peak frequency. Control group comparisons were made for measures that differed between responders and non-responders. A machine learning algorithm assessed the potential to differentiate responders from non-responders using EEG measures in combination with change in depression scores from BL to W1. RESULTS: Responders showed elevated theta connectivity across BL and W1. No other EEG measures differed between groups. Responders could be distinguished from non-responders with a mean sensitivity of 0.84 (p = 0.001) and specificity of 0.89 (p = 0.002) using cross-validated machine learning classification on the combination of all EEG and mood measures. LIMITATIONS: The low response rate limited our sample size to only 12 responders. CONCLUSION: Resting theta connectivity at BL and W1 differ between responders and non-responders, and show potential for predicting response to rTMS treatment for depression.


Assuntos
Transtorno Depressivo Maior/terapia , Transtorno Depressivo Resistente a Tratamento/diagnóstico , Estimulação Magnética Transcraniana/métodos , Adulto , Idoso , Algoritmos , Transtorno Depressivo Maior/fisiopatologia , Eletroencefalografia/métodos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Sensibilidade e Especificidade , Adulto Jovem
14.
Br J Psychiatry ; 214(1): 27-35, 2019 01.
Artigo em Inglês | MEDLINE | ID: mdl-30520709

RESUMO

BACKGROUND: Most people with bipolar disorder spend a significant percentage of their lifetime experiencing either subsyndromal depressive symptoms or major depressive episodes, which contribute greatly to the high levels of disability and mortality associated with the disorder. Despite the importance of bipolar depression, there are only a small number of recognised treatment options available. Consecutive treatment failures can quickly exhaust these options leading to treatment-resistant bipolar depression (TRBD). Remarkably few studies have evaluated TRBD and those available lack a comprehensive definition of multi-therapy-resistant bipolar depression (MTRBD).AimsTo reach consensus regarding threshold definitions criteria for TRBD and MTRBD. METHOD: Based on the evidence of standard treatments available in the latest bipolar disorder treatment guidelines, TRBD and MTRBD criteria were agreed by a representative panel of bipolar disorder experts using a modified Delphi method. RESULTS: TRBD criteria in bipolar depression was defined as failure to reach sustained symptomatic remission for 8 consecutive weeks after two different treatment trials, at adequate therapeutic doses, with at least two recommended monotherapy treatments or at least one monotherapy treatment and another combination treatment. MTRBD included the same initial definition as TRBD, with the addition of failure of at least one trial with an antidepressant, a psychological treatment and a course of electroconvulsive therapy. CONCLUSIONS: The proposed TRBD and MTRBD criteria may provide an important signpost to help clinicians, researchers and stakeholders in judging how and when to consider new non-standard treatments. However, some challenging diagnostic and therapeutic issues were identified in the consensus process that need further evaluation and research.Declaration of interestIn the past 3 years, M.B. has received grant/research support from the NIH, Cooperative Research Centre, Simons Autism Foundation, Cancer Council of Victoria, Stanley Medical Research Foundation, MBF, NHMRC, Beyond Blue, Rotary Health, Geelong Medical Research Foundation, Bristol Myers Squibb, Eli Lilly, Glaxo SmithKline, Meat and Livestock Board, Organon, Novartis, Mayne Pharma, Servier, Woolworths, Avant and the Harry Windsor Foundation, has been a speaker for Astra Zeneca, Bristol Myers Squibb, Eli Lilly, Glaxo SmithKline, Janssen Cilag, Lundbeck, Merck, Pfizer, Sanofi Synthelabo, Servier, Solvay and Wyeth and served as a consultant to Allergan, Astra Zeneca, Bioadvantex, Bionomics, Collaborative Medicinal Development, Eli Lilly, Grunbiotics, Glaxo SmithKline, Janssen Cilag, LivaNova, Lundbeck, Merck, Mylan, Otsuka, Pfizer and Servier. A.C. has received fees for lecturing from pharmaceutical companies namely Lundbeck and Sunovion. A.J.C. has in the past 3 years received honoraria for speaking from Astra Zeneca and Lundbeck, honoraria for consulting from Allergan, Janssen, Lundbeck and LivaNova and research grant support from Lundbeck. G.M.G. holds shares in P1Vital and has served as consultant, advisor or CME speaker for Allergan, Angelini, Compass pathways, MSD, Lundbeck, Otsuka, Takeda, Medscape, Minervra, P1Vital, Pfizer, Servier, Shire and Sun Pharma. J.G. has received research funding from National Institute for Health Research, Medical Research Council, Stanley Medical Research Institute and Wellcome. H.G. received grants/research support, consulting fees or honoraria from Gedeon Richter, Genericon, Janssen Cilag, Lundbeck, Otsuka, Pfizer and Servier. R.H.M.-W. has received support for research, expenses to attend conferences and fees for lecturing and consultancy work (including attending advisory boards) from various pharmaceutical companies including Astra Zeneca, Cyberonics, Eli Lilly, Janssen, Liva Nova, Lundbeck, MyTomorrows, Otsuka, Pfizer, Roche, Servier, SPIMACO and Sunovion. R.M. has received research support from Big White Wall, Electromedical Products, Johnson and Johnson, Magstim and P1Vital. S.N. received honoraria from Lundbeck, Jensen and Otsuka. J.C.S. has received funds for research from Alkermes, Pfizer, Allergan, J&J, BMS and been a speaker or consultant for Astellas, Abbott, Sunovion, Sanofi. S.W has, within the past 3 years, attended advisory boards for Sunovion and LivaNova and has undertaken paid lectures for Lundbeck. D.J.S. has received honoraria from Lundbeck. T.S. has reported grants from Pathway Genomics, Stanley Medical Research Institute and Palo Alto Health Sciences; consulting fees from Sunovion Pharamaceuticals Inc.; honoraria from Medscape Education, Global Medical Education and CMEology; and royalties from Jones and Bartlett, UpToDate and Hogrefe Publishing. S.P. has served as a consultant or speaker for Janssen, and Sunovion. P.T. has received consultancy fees as an advisory board member from the following companies: Galen Limited, Sunovion Pharmaceuticals Europe Ltd, myTomorrows and LivaNova. E.V. received grants/ research support, consulting fees or honoraria from Abbott, AB-Biotics, Allergan, Angelini, Dainippon Sumitomo, Ferrer, Gedeon Richter, Janssen, Lundbeck, Otsuka and Sunovion. L.N.Y. has received grants/research support, consulting fees or honoraria from Allergan, Alkermes, Dainippon Sumitomo, Janssen, Lundbeck, Otsuka, Sanofi, Servier, Sunovion, Teva and Valeant. A.H.Y. has undertaken paid lectures and advisory boards for all major pharmaceutical companies with drugs used in affective and related disorders and LivaNova. He has also previously received funding for investigator-initiated studies from AstraZeneca, Eli Lilly, Lundbeck and Wyeth. P.R.A.S. has received research funding support from Corcept Therapeutics Inc. Corcept Therapeutics Inc fully funded attendance at their internal conference in California USA and all related expenses. He has received grant funding from the Medical Research Council UK for a collaborative study with Janssen Research and Development LLC. Janssen Research and Development LLC are providing non-financial contributions to support this study. P.R.A.S. has received a presentation fee from Indivior and an advisory board fee from LivaNova.


Assuntos
Antidepressivos/uso terapêutico , Transtorno Bipolar/diagnóstico , Transtorno Depressivo Maior/diagnóstico , Transtorno Depressivo Resistente a Tratamento/diagnóstico , Transtorno Bipolar/tratamento farmacológico , Consenso , Depressão/diagnóstico , Depressão/tratamento farmacológico , Transtorno Depressivo Maior/tratamento farmacológico , Transtorno Depressivo Resistente a Tratamento/tratamento farmacológico , Humanos
15.
Br J Psychiatry ; 214(1): 1-3, 2019 01.
Artigo em Inglês | MEDLINE | ID: mdl-30565539

RESUMO

Treatment-resistant depression is widely defined as non-response to two 'adequate' courses of treatment. However, the definitions of treatment and depression are inconsistent reflecting gaps in our understanding. We argue that a failure to respond is often the result of administering inappropriate treatment, which occurs principally because of paradigm failure.Declaration of interestNone.


Assuntos
Antidepressivos/uso terapêutico , Transtorno Depressivo Resistente a Tratamento/diagnóstico , Transtorno Depressivo Resistente a Tratamento/tratamento farmacológico , Humanos , Índice de Gravidade de Doença , Falha de Tratamento
16.
Br J Psychiatry ; 212(5): 274-278, 2018 05.
Artigo em Inglês | MEDLINE | ID: mdl-30517072

RESUMO

Many novel therapeutic options for depression exist that are either not mentioned in clinical guidelines or recommended only for use in highly specialist services. The challenge faced by clinicians is when it might be appropriate to consider such 'non-standard' interventions. This analysis proposes a framework to aid this decision.Declaration of interestIn the past 3 years R.H.M.W. has received support for research, expenses to attend conferences and fees for lecturing and consultancy work (including attending advisory boards) from various pharmaceutical companies including Astra Zeneca, Cyberonics, Eli Lilly, Janssen, LivaNova, Lundbeck, MyTomorrows, Otsuka, Pfizer, Roche, Servier, SPIMACO and Sunovion. D.M.B.C. has received fees from LivaNova for attending an advisory board. In the past 3 years A.J.C. has received fees for lecturing from Astra Zeneca and Lundbeck; fees for consulting from LivaNova, Janssen and Allergan; and research grant support from Lundbeck.In the past 3 years A.C. has received fees for lecturing from pharmaceutical companies namely Lundbeck and Sunovion. In the past 3 years A.L.M. has received support for attending seminars and fees for consultancy work (including advisory board) from Medtronic Inc and LivaNova. R.M. holds joint research grants with a number of digital companies that investigate devices for depression including Alpha-stim, Big White Wall, P1vital, Intel, Johnson and Johnson and Lundbeck through his mindTech and CLAHRC EM roles. M.S. is an associate at Blueriver Consulting providing intelligence to NHS organisations, pharmaceutical and devices companies. He has received honoraria for presentations and advisory boards with Lundbeck, Eli Lilly, URGO, AstraZeneca, Phillips and Sanofi and holds shares in Johnson and Johnson. In the past 3 years P.R.A.S. has received support for research, expenses to attend conferences and fees for lecturing and consultancy work (including attending an advisory board) from life sciences companies including Corcept Therapeutics, Indivior and LivaNova. In the past 3 years P.S.T. has received consultancy fees as an advisory board member from the following companies: Galen Limited, Sunovion Pharmaceuticals Europe Ltd, myTomorrows and LivaNova. A.H.Y. has undertaken paid lectures and advisory boards for all major pharmaceutical companies with drugs used in affective and related disorders and LivaNova. He has received funding for investigator initiated studies from AstraZeneca, Eli Lilly, Lundbeck and Wyeth.


Assuntos
Transtorno Depressivo Maior/terapia , Transtorno Depressivo Resistente a Tratamento/terapia , Transtorno Depressivo Maior/diagnóstico , Transtorno Depressivo Resistente a Tratamento/diagnóstico , Humanos
17.
Psychiatr Danub ; 30(3): 273-284, 2018 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-30267518

RESUMO

Guidelines for the management of treatment-resistant depression (TRD) do not meet the criteria of evidence-based medicine and better-quality research is required to inform clinical practice. Current treatments of resistant depression remains largely empirical. There are no bench-mark antidepressants. Clear and justifiable rationale should be followed while initiating new treatment strategies; systematic planning and careful monitoring of progress implemented while new treatment components are added. Biological psychiatrists should give due importance to the non-biological aspects of depression and psychotherapists should not overlook the biological correlates. Unidimensional solution will not work for a complex illness like refractory depression and a single answer should not be sought as a cure because the aetiology of depression is multifactorial and the pathophysiology itself remains unknown. Psychopharmacological interventions are still the main stay of treatment of TRD. There are two major alternatives to pharmacotherapy: neuromodulation and psychotherapy. Alternative terminologies for TRD like MTR-MDD (Multiple Therapy Resistant-Major Depressive Disorder) are being introduced reflecting the frustrations of clinicians and patients with the conventional definition of TRD and treatment modalities.


Assuntos
Antidepressivos/uso terapêutico , Transtorno Depressivo Maior/terapia , Transtorno Depressivo Resistente a Tratamento/terapia , Psicoterapia , Estimulação Elétrica Nervosa Transcutânea , Terapia Combinada , Comorbidade , Transtorno Depressivo Maior/diagnóstico , Transtorno Depressivo Maior/psicologia , Transtorno Depressivo Resistente a Tratamento/diagnóstico , Transtorno Depressivo Resistente a Tratamento/psicologia , Eletroconvulsoterapia , Medicina Baseada em Evidências , Fidelidade a Diretrizes , Humanos , Equipe de Assistência ao Paciente , Resultado do Tratamento
18.
J Psychosoc Nurs Ment Health Serv ; 56(9): 11-15, 2018 Sep 01.
Artigo em Inglês | MEDLINE | ID: mdl-30168841

RESUMO

Treatment-resistant depression (TRD) refers to depression that fails to remit after at least two to four medication and psychotherapy treatment strategies. TRD carries significant personal burden and risk for suicide and poses substantial burden to society. Less than 30% of individuals diagnosed with major depressive disorder achieve complete remission of symptoms. Using the evidence-based predictors of TRD in the initial assessment of patients, clinicians can arrive at a treatment plan to improve outcomes. The current article includes first-line medications based on symptom presentation as well as augmentation and more aggressive treatment recommendations for patients who continue to experience depressive symptoms beyond 6 months of effective dose and time trials of treatment. [Journal of Psychosocial Nursing and Mental Health Services, 56(9), 11-15.].


Assuntos
Antidepressivos de Segunda Geração/uso terapêutico , Antidepressivos Tricíclicos/uso terapêutico , Transtorno Depressivo Resistente a Tratamento , Quimioterapia Combinada , Psicoterapia , Transtorno Depressivo Resistente a Tratamento/diagnóstico , Transtorno Depressivo Resistente a Tratamento/tratamento farmacológico , Humanos , Fatores de Tempo
19.
J Clin Psychopharmacol ; 38(5): 502-504, 2018 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-30106881

RESUMO

BACKGROUND: Few therapeutic options are available for patients with electroconvulsive therapy-resistant major depressive disorder (ECT-r MDD), leaving a substantial proportion of this population beyond treatment possibilities. The combination of monoamine oxidase inhibitors and tricyclic antidepressants could be a potential strategy for managing ECT-r MDD, and the specific association of amitriptyline and tranylcypromine may offer additional tolerability advantages. Although promising, in our knowledge, no studies have examined until now the effectiveness of this combination in ECT-r MDD. METHODS: We report a retrospective cohort of 31 patients with ECT-r MDD treated in an open-label fashion with the combination of amitriptyline and tranylcypromine. RESULTS: Overall, 80.6% of the sample met response criteria at the end of the first 12 weeks of treatment. Seventy-six percent (19 of 25) of the responders were followed for a mean of 9.37 ± 3.86 years. During this follow-up period, none of the patients had a recurring depressive episode. The combination was well tolerated, whereas minor adverse effects were common, and no severe or life-threatening events were reported throughout the study. CONCLUSIONS: These findings indicate that the combination tranylcypromine and amitriptyline is a potentially safe and effective candidate for future investigation in the treatment and long-term maintenance of ECT-r MDD.


Assuntos
Amitriptilina/administração & dosagem , Antidepressivos/administração & dosagem , Transtorno Depressivo Resistente a Tratamento/tratamento farmacológico , Transtorno Depressivo Resistente a Tratamento/psicologia , Eletroconvulsoterapia , Tranilcipromina/administração & dosagem , Adulto , Antidepressivos Tricíclicos/administração & dosagem , Estudos de Coortes , Transtorno Depressivo Resistente a Tratamento/diagnóstico , Quimioterapia Combinada , Eletroconvulsoterapia/tendências , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Tempo
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