Hostname: page-component-76fb5796d-wq484 Total loading time: 0 Render date: 2024-04-26T09:17:21.865Z Has data issue: false hasContentIssue false

Emerging Treatment Options in Treatment-Resistant Depression and Anxiety Disorders

Published online by Cambridge University Press:  07 November 2014

Abstract

Management strategies for treatment-resistant depression and anxiety disorders have evolved over the last decade. Our understanding of the factors that impair recovery from an episode of major depression has increased, leading to the development of more precise diagnostic methodology that highlight the presence of comorbid conditions. New medications, creative uses of existing medications, increased empirical data about augmentation strategies, and the development of innovative nonpharmacologic interventions are responsible for a marked expansion in treatment options. Traditionally, augmentations with lithium, thyroid hormones, or electroconvulsive therapy have demonstrated effectiveness in some patients with treatment-resistant mood disorders. Among the promising treatments in both depression and anxiety is augmentation using low-dose antipsychotics medications, combining antidepressants of different classes, and the addition of psychotherapy. Nonpharmacologic interventions that may have potential include transcranial magnetic stimulation, deep-brain stimulation, and vagus-nerve stimulation. This article provides a brief review of the available data summarizing existing and new treatment strategies in depression and anxiety disorders.

Type
Research Article
Copyright
Copyright © Cambridge University Press 2002

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

REFERENCES

1.AJ, Rush, Crismon, ML, Toprac, MG, et al.Implementing guidelines and systems of care: experiences with the Texas Medication Algorithm Project (TMAP). J Pract Psychiatry Behav Health. 1999;5:7586.Google Scholar
2.Fava, M, Rush, AJ, Trivedi, MH, et al.Background and rationale for the sequenced treatment alternatives to relieve depression (STAR*D) study. Psychiatr Clin North Am. 2003;26(2):457494.CrossRefGoogle ScholarPubMed
3.World Health Organization. The World Health Report Mental Health: New Understanding, New Hope. Geneva, Switzerland: WHO; 2001.Google Scholar
4.Judd, LL, Akiskal, HS, Maser, JD, et al.A prospective 12-year study of subsyndromal and syndromal depressive symptomatology in unipolar major depressive disorders. Arch Gen Psychiatry. 1998;55:694701.Google Scholar
5.Rush, AJ, Ryan, ND. In: DS, Charneyet al, eds. Neuropsychopharmacology. The Fifth Generation of Progress. Baltimore, MD: Lippincott Williams & Wilkins; 2002:10811096.Google Scholar
6.Bauer, M, Whybrow, PC, Angst, J, et al.World Federation of Societies of Biological Psychiatry (WFSBP) Guidelines for Biological Treatment of Unipolar Depressive Disorders, Part 2: Maintenance treatment of major depressive disorder and treatment of chronic depressive disorders and subthreshold depressions. World J Biol Psychiatry. 2002;3(2):6986.Google Scholar
7.Rush, AJ, Crismon, ML, Toprac, MG, et al.Consensus guidelines in the treatment of major depressive disorder. J Clin Psychiatry. 1998;59(suppl 20):7384.Google Scholar
8.Gabbard, GO, ed. Treatment of Psychiatric Disorders. 3rd ed. Vols. 1 and 2. Washington, DC; American Psychiatric Publishing, Inc; 2001.Google Scholar
9.Thase, ME, Howland, RH, Friedman, ES. Treating antidepressant non-responders with augmentation strategies: an overview. J Clin Psychiatry. 1998;59(Suppl 5):512.Google Scholar
10.Price, LH, Chamey, DS. Delgado, PL, et al.Fenfluramine augmentation in tricyclic-refractory depression. J Clin Psychopharmacol. 1990;10:312317.CrossRefGoogle ScholarPubMed
11.Himmelhoch, JM, Detre, T, Kupfer, DJ, Swartzburg, M, Byck, R. Treatment of previously intractable depressions with tranylcypromine and lithium. J Nerv Ment Dis. 1972;155(3):216220.CrossRefGoogle ScholarPubMed
12.Price, LH, Charney, DS, Heninger, GR. Efficacy of lithium-tranylcypromine treatment in refractory depression. Am J Psychiatry. 1985;142:619623.Google Scholar
13.Fein, S, Paz, V, Rao, N, LaGrassa, J. The combination of lithium carbonate and an MAOI in refractory depressions. Am J Psychiatry. 1988;145(2):249250.Google Scholar
14.Dinan, TG. Lithium augmentation in sertraline-resistant depression: a preliminary dose-response study. Acta Psychiatr Scand. 1993;88(4):300301.CrossRefGoogle ScholarPubMed
15.Baumann, P, Nil, R, Souche, A, et al.A double-blind, placebo-controlled study of Citalopram with and without lithium in the treatment of therapy-resistant depressive patients: a clinical, pharmacokinetic, and pharmacogenetic investigation. J Clin Psychopharmacol. 1996;16(4):307314.CrossRefGoogle ScholarPubMed
16.Fava, M.Rosenbaum, JF, Grossbard, SJ, et al.Lithium and tricyclic augmentation of fluoxetine treatment for resistant major depression: a double blind, controlled study. Am J Psychiatry. 1994;151:13721374.Google Scholar
17.CLE, Katona, Abou-Saleh, MT, Harrison, DA, et al.Placebo-controlled trial of lithium augmentation of fluoxetine and lofepramine. Br J Psychiatry. 1995;166:8086.Google Scholar
18.Salama, AA, Shafey, M. A case of severe lithium toxicity induced by combined fluoxetine and lithium carbonate. Am J Psychiatry. 1989;146(2):278.Google ScholarPubMed
19.Nelson, JC. Overcoming treatment tesistance in depression. J Clin Psychiatry. 1998;59(Suppl 16):1319.Google Scholar
20.Bauer, M, Adli, M, Baethge, C, et al.Lithium augmentation therapy in refractory depression: clinical evidence and neurobiological mechanisms. Can J Psychiatry. 2003;48(7):440448.Google Scholar
21.Gitlin, MJ, Weiner, H, Fairbanks, L, Hershman, JM, Friedfeld, N. Failure of T3 to potentiate tricyclic antidepressant response. J Affect Disord. 1987;13:267272.Google Scholar
22.Nelson, JC. Treatment of antidepressant nonresponders: augmentation or switch? J Clin Psychiatry. 1998;59(Suppl 15):3541.Google Scholar
23.Marshall, RD, Liebowitz, MR. Paroxetine/bupropion combination treatment for refractory depression. J Clin Psychopharmacol. 1996;16(1):8081.CrossRefGoogle ScholarPubMed
24.Bodkin, JA, Lasser, RA, Wines, JD Jr, Gardner, DM, Baldessarini, RJ, Combining serotonin reuptake inhibitors and bupropion in partial responded to antidepressant monotherapy. J Clin Psychiatry. 1997;58:137145.CrossRefGoogle ScholarPubMed
25.Spier, SA. Use of bupropion with SRIs and venlafaxine. Depress Anxiety. 1998;7(2):7375.Google Scholar
26.Labbate, LA, Grimes, JB, Hines, A, et al.Bupropion treatment of serotonin reuptake antidepressant-associated sexual dysfunction. Ann Clin Psychiatry. 1997;9:241245.CrossRefGoogle ScholarPubMed
27.Ashton, AK, Rosen, RC. Bupropion as an antidote for serotonin reuptake inhibitor-induced sexual dysfunction. J Clin Psychiatry. 1998;59(3):112115.Google Scholar
28.Young, SJ. Panic associated with combining fluoxetine and bupropion. J Clin Psychiatry. 1996;57(4):177178.Google Scholar
29.Seth, R, Jennings, AL, Bindman, J, Phillips, J, Bergmann, K. Combination treatment with noradrenalin and serotonin reuptake inhibitors in resistant depression. Br J Psychiatry. 1992;161:562565.Google Scholar
30.Zajeckax, JM, Jeffries, H, Fawcett, J. The efficacy of fluoxetine combined with a heterocyclic antidepressant in treatment-resistant depression: a retrospective analysis. J Clin Psychiatry. 1995;56(8):338343.Google Scholar
31.Nelson, JC, Mazure, CM, Bowers, MB Jr, Jatlow, PI. A preliminary, open study of the combination of fluoxetine and desipramine for rapid treatment of major depression. Arch Gen Psychiatry. 1991;48(4):303307.CrossRefGoogle ScholarPubMed
32.Fava, M, JF, RosenbaumMcGrath, PJ, Stewart, JW, Amsterdam, JD, Quitkin, FM. Lithium and tricyclic augmentation of fluoxetine treatment for resistant major depression: a double-blind, controlled study. Am J Psychiatry. 1994;151(9):13721374.Google ScholarPubMed
33.Carpenter, LL, Yasmin, S, Price, LH. A double-blind, placebo-controlled study of antidepressant augmentation with mirtazapine. Biol Psychiatry. 2002;51(2):183188.CrossRefGoogle ScholarPubMed
34.Dam, J, Ryde, L, Svejso, J, Lauge, N, Lauritsen, B, Bech, P. Morning fluoxetine plus evening mianserin versus morning fluoxetine plus evening placebo in the acute treatment of major depression. Pharmacopsychiatry. 1998;31(2):4854.Google Scholar
35.Menza, MA, Kaufman, KR, Castellanos, A. Modafinil augmentation of antidepressant treatment in depression. J Clin Psychiatry. 2000;61(5):378381.Google Scholar
36.Hertel, P, Nomikos, GG, Schilstrom, B, Arborelius, L, Svensson, TH. Risperidone dose-dependently increases extracellular concentrations of serotonin in the rat frontal cortex: role of alpha 2-adrenoceptor antagonism. Neuropsychopharmacology. 1997;17(1):4455.CrossRefGoogle ScholarPubMed
37.Szabo, ST, Blier, P. Effects of serotonin (5-hydroxytryptamine, 5-HT) reuptake inhibition plus 5-HT(2A) receptor antagonism on the firing activity of norepinephrine neurons. J Pharmacol Exp Ther. 2002;302(3):983991.Google Scholar
38.Wakade, CG, Mahadik, SP, Waller, JL, Chiu, FC. Atypical neuroleptics stimulate neurogenesis in adult rat brain. J Neurosci Res. 2002;69(1):7279.Google Scholar
39.Koch, S, Perry, KW, Bymaster, FP. Brain region and dose effects of an olanzapine/fluoxetine combination on extracellular monoamine concentration in the rat. Neuropharmacology. 2004;46(2):232242.Google Scholar
40.Zhang, W, Perry, KW, Wong, DT, Potts, BD, Tollefson, GD, Bymaster, FP. Synergistic effects of olanzapine and other antipsychotic agents in combination with fluoxetine on norepinephrine and dopamine release in rat prefrontal cortex. Neuropsychopharmacology. 2000;23(3):250262.Google Scholar
41.RC, Shelton, Tollefson, GD, Tohen, M, et al.A novel augmentation strategy for treating resistant major depression. Am J Psychiatry. 2001;158(1):131134.Google Scholar
42.Corya, SA, Andersen, SW, Detke, HC, et al.Long term antidepressant efficacy and safety of olanzapine/fluoxetine combination: a 76-week open label study. J Clin Psychiatry. 2003;64(11):13491356.CrossRefGoogle ScholarPubMed
43.Parker, G. Olanzapine augmentation in the treatment of melancholia: the trajectory of improvement in rapid responders. Int Clin Psychopharmacol. 2002;17(2):8789.CrossRefGoogle ScholarPubMed
44.Papakostas, GI, TJ, Petersen, Nierenberg, AA, et al.Ziprasidone augmentation of selective serotonin reuptake inhibitors (SSRIs) for SSRI-resistant major depressive disorder. J Clin Psychiatry. 2004;65(2):217221.Google Scholar
45.Dunnet, DL, Amsterdam, JD, Shelton, RC, Hassman, H, Rosenthal, M, Romano, SJ. Adjunctive ziprasidone in treatment-resistant depression: pilot study. Presented at: Annual Meeting of the American College of Neuropsychopharmacology; 12 2003; San Juan, Puerto Rico.Google Scholar
46.Ostroff, RB, Nelson, JC. Risperidone augmentation of selective serotonin reuptake inhibitors in major depression. J Clin Psychiatry. 1999;69(4):256259.Google Scholar
47.Tani, K, Takei, N, Kawai, M, et al.Augmentation of milnacipran by risperidone in treatment for major depression. Int J Neuropsychopharmacol. 2004;7(1):5558.CrossRefGoogle ScholarPubMed
48.Adson, DE, Kushner, MG, Eiben, KM, Schulz, SC. Preliminary experience with adjunctive quetiapine in patients receiving selective serotonin reuptake inhibitors. Depress Anxiety. 2004;19(2):121126.Google Scholar
49.Worthington, J, Kinrys, G, Fava, M, Dording, C, Reese, H, Pollack, M. Aripiprazole as an augmentor of SSRIs in mood and anxiety disorder patients. Poster presented at: Annual Meeting of the New Clinical Drug Evaluation Unit; 06 2004; Phoenix, AZ.Google Scholar
50.Keller, MB, McCullough, JP, Klein, DN, Arnow, B, et al.A comparison of nefazodone, the cognitive behavioral-analysis system of psychotherapy, and their combination for the treatment of chronic depression. N Engl J Med. 2000;342:14621470.CrossRefGoogle ScholarPubMed
51.Depression Guideline Panel. Depression in Primary Care. Vol. 2. Treatment of Major Depression. Clinical Practice Guideline. Rockville, MD: US Dept. of Health and Human Services, Agency for Health Care Policy and Research; AHCPR Publication No. 93-0551; 1993.Google Scholar
52.Nemeroff, CB, Heim, CM, Thase, ME, et al.Differential responses to psychotherapy versus pharmacotherapy in patients with chronic forms of major depression and childhood trauma. Proc Natl Acad Sci U S A. 2003;100(24):1429314296.Google Scholar
53.George, MS, Nahas, Z, Kozel, FA, Goldman, J, Molloy, M, Oliver, N. Improvement of depression following transcranial magnetic stimulation. Curr Psychiatry Rep. 1999;1:114124.Google Scholar
54.PE, Holtzheimer 3rd, Russo, J, Avery, DH. A meta-analysis of repetitive transcranial magnetic stimulation in the tteatment of depression. Psychopharmacol Bull. 2001;35(4):149169.Google Scholar
55.Burt, T, Lisanby, SH, Sackeim, HA. Neuropsychiatric applications of transcranial magnetic stimulation: a meta analysis. Int J Neuropsychopharmacol. 2002;5(1):73103.Google Scholar
56.Marangell, LB, Rush, AJ, George, MS, et al.Vagus nerve stimulation (VNS) for major depressive episodes: one year outcomes. Biol Psychiatry. 2002;51:280287Google Scholar
57.Sackeim, HA, Rush, AJ, George, MS, et al.Vagus nerve stimulation (VNS) for treatment-resistant depression: efficacy, side effects, and predictors of outcome. Neuropsychopharmacology. 2001;25(5):713728.Google Scholar
58.Stein, MB, Kline, NA, and JL, Matloff. Adjunctive olanzapine for SSRI-resistant combat-related PTSD: A double-blind, placebo-controlled study. Am J Psychiatry. 2002;159:17771779.Google Scholar
59.Bartzokis, G, Freeman, T, Roca, V. Antipsychotic augmentation in patients with chronic combat-related post-traumatic stress disorder. Presented at: Annual Meeting of the New Clinical Drug Evaluation Unit; 06 2001; Phoenix, AZ.Google Scholar
60.Hamner, MB, Deitsch, SE, Brodrick, PS, Ulmer, HG, Lorbetbaum, JP. Quetiapine treatment in patients with posttraumatic stress disorder: an open trial of adjunctive therapy. J Clin Psychopharmacol. 2003;23(1):1520.CrossRefGoogle ScholarPubMed
61.Sevincok, L, Topuz, A. Lack of efficacy of low doses of quetiapine addition in refractory obsessive-compulsive disorder. J Clin Psychopharmacol. 2003;23(5):448450.CrossRefGoogle ScholarPubMed
62.Atmaca, M, Kuloglu, M, Tezcan, E, Gecici, O. Quetiapine augmentation in patients with treatment resistant obsessive-compulsive disorder: a single-blind, placebo-controlled study. Int Clin Psychopharmacol. 2002;17(3):115119.Google Scholar
63.CJ, McDougleEpperson, CN, Pelton, GH, Wasylink, S, Price, LH. A double-blind, placebo-controlled study of risperidone addition in serotonin reuptake inhibitor-refractory obsessive-compulsive disorder. Arch Gen Psychiatry. 2000;57:794801.Google Scholar
64.Brawman-Mintzer, O. Risperidone augmentation in treatment-resistant generalized anxiety disorder. Poster presented at; Annual Meeting of European College of Neuropsychopharmacology; 09 20-24, 2003; Prague, Czech Republic.Google Scholar
65.Caspi, A, Sugden, K, Moffitt, TE, et al.Influence of life stress on depression: moderation by a polymorphism in the 5-HTT gene. Science. 2003;301:386389.Google Scholar
66.Smeraldi, E, Zanardi, R, Benedetti, F, Di Bella, D, Perez, J, Catalano, M. Polymorphism within the promoter of the serotonin transporter gene and antidepressant efficacy of fluvoxamine. Mol Psychiatry. 1998;3(6):508511.Google Scholar