Hostname: page-component-78c5997874-v9fdk Total loading time: 0 Render date: 2024-11-17T14:38:36.442Z Has data issue: false hasContentIssue false
  • English
  • Français

Toward Optimal Treatments for Major Depression

Published online by Cambridge University Press:  07 November 2014

Pierre Blier  and
Herbert Ward
Get access Rights & Permissions [Opens in a new window]

Abstract

The treatment of major depression remains problematic for several reasons. In particular, the therapeutic response to medications usually does not manifest itself until a week after administration has begun, and more than half the patients will not experience a full recovery with the first antidepressant drug administration. There are, however, some pharmacologic strategies that can accelerate antidepressant response. When facing a treatment-resistant depression, combination therapy offers a more time-efficient approach to achieve remission than drug substitution. These interventions have been devised on a better understanding of the basis for the therapeutic response obtained with the first- and second-generation antidepressants, and evidence derived from controlled clinical trials of their superior effectiveness is growing. The rationale for such approaches will be described in this article, as well as their advantages and potential inconveniences. Ongoing research in this field continues to fuel the development of novel, better-tolerated, and more effective pharmacotherapies for depression.

Type
Feature Article
Information
CNS Spectrums , Volume 7 , Issue 2 , February 2002 , pp. 148 - 154
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.Nemeroff, CB, DeVane, CL, Pollock, BG. Newer antidepressants and the cytochrome P450 system. Am J Psychiatry. 1996;153:311–320.Google ScholarPubMed
2.Angst, J. How recurrent and predictable is depressive illness? Persp Psychiatry. 1992;3:1–13.Google Scholar
3.Zanardi, R, Serretti, A, Rossinni, D, et al.Factors affecting fluvoxamine antidepressant activity: influence of pindolol and 5-HTTLPR in delusional and non-delusional depression. Biol Psychiatry. 2001;50:323–330.CrossRefGoogle Scholar
4.Sayal, KS, Duncan-McConnell, DA, McConnell, HW, Taylor, DM. Psychotropic interactions with warfarin. Acta Psychiatr Scand. 2000;102:250–255.CrossRefGoogle ScholarPubMed
5.Owens, JR, Nemeroff, CB. New antidepressants and the cytochrome P450 system: focus on venlafaxine, nefazodone and mirtazapine. Depress Anxiety. 1998;7(suppl 1):24–32.3.0.CO;2-F>CrossRefGoogle Scholar
6.McCall, WV, Reboussin, DM, Weiner, RD, Sackeim, HA. Titrated moderately suprathreshold vs fixed high-dose right unilateral electroconvulsive therapy: acute antidepressant and cognitive effects. Arch Gen Psychiatry. 2000;57:438–444.CrossRefGoogle ScholarPubMed
7.Smeraldi, E, Benedetti, F, Barbini, B, Campori, E, Colombo, C. Sustained antidepressant effect of sleep deprivation combined with pindolol in bipolar depression. A placebo-controlled trial. Neuropsychopharmacology. 1999;20:380–385.CrossRefGoogle ScholarPubMed
8.Blier, P, de Montigny, C. Serotonin and drug-induced therapeutic responses in major depression, obsessive-compulsive and panic disorders. Neuropsychopharmacology. 1999;21(suppl 2):91S–98S.CrossRefGoogle ScholarPubMed
9.Kreiss, DS, Lucki, I. Effects of acute and repeated administration of antidepressant drugs on extracellular levels of 5-hydroxytryptamine measured in vivo. J Pharmacol Exp Ther. 1995;274:866–876.Google ScholarPubMed
10.Rutter, JJ, Gundlah, C, Auerbach, SB. Increase in extracellular serotonin produced by uptake inhibitors is enhanced after chronic treatment with fluoxetine. Neurosci Lett. 1994;171:183–186.CrossRefGoogle ScholarPubMed
11.Delgado, PL, Miller, HL, Salomon, RM, et al.Tryptophan-depletion challenge in depressed patients treated with desipramine or fluoxetine: implications for the role of serotonin in the mechanism of antidepressant action. Biol Psychiatry. 1999;46:212–220.CrossRefGoogle ScholarPubMed
12.Martinez, D, Broft, A, Laruelle, M. Pindolol augmentation of antidepressant treatment: recent contributions from brain imaging studies. Biol Psychiatry. 2000;48:844–853.CrossRefGoogle ScholarPubMed
13.Rabiner, EA, Gunn, RN, Castro, ME, et al.Beta-blocker binding to human 5-HT(1A) receptors in vivo and in vitro: implications for antidepressant therapy. Neuropsychopharmacol. 2000;23:285–293.CrossRefGoogle ScholarPubMed
14.Maes, M, Vandoolaeghe, E, Desnyder, R. Efficacy of treatment with trazodone in combination with pindolol or fluoxetine in major depression. J Affect Disord. 1996;41:201–210.Google ScholarPubMed
15.Perez, V, Gilaberte, E, Faries, D, Alvarez, E, Artigas, F. Randomised, double-blind, placebo-controlled trial of pindolol in combination with fluoxetine antidepressant treatment. Lancet. 1997;349:1594–1597.CrossRefGoogle ScholarPubMed
16.Zanardi, R, Artigas, F, Franchini, L, et al.How long should pindolol be associated with paroxetine to improve the antidepressant response? J Clin Psychopharmacol. 1998;17:446–450.CrossRefGoogle Scholar
17.Zanardi, R, Franchini, L, Gaseperini, M, et al.Faster onset of action fluvoxamine in combination with pindolol in the treatment of delusional depression: a controlled study. J Clin Psychopharmacol. 1998;18:441–446.CrossRefGoogle ScholarPubMed
18.Tome, MB, Isaac, MT, Harte, R, Holland, C. Paroxetine and pindolol: a randomized trial of serotonergic autoreceptor blockade in the reduction of antidepressant latency. Int Clin Psychopharmacol. 1997;12:81–89.CrossRefGoogle ScholarPubMed
19.Bordet, R, Thomas, P, Dupuis, B. Effect of pindolol on onset of action of paroxetine in the treatment of major depression: intermediate analysis of a double-blind, placebo-controlled trial. Am J Psychiatry. 1998;155:1346–1351.CrossRefGoogle ScholarPubMed
20.Maes, M, Libbrecht, I, Van Hunsel, F, Campens, D, Meltzer, HY. Pindolol and mianserin augment the antidepressant activity of fluoxetine in hospitalized major depressed patients, including those with treatment resistance. J Clin Psychopharmacol. 1999;19:177–182.CrossRefGoogle ScholarPubMed
21.Berman, RM, Anand, A, Cappiello, A, et al.The use of pindolol with fluoxetine in the treatment of major depression: final results from a double-blind, placebo-controlled trial. Biol Psychiatry. 1999;45:1170–1177.CrossRefGoogle ScholarPubMed
22.Perez, V, Soler, J, Puigdemont, D, Alvarez, E, Artigas, F. A double-blind, randomized, placebo-controlled trial of pindolol augmentation in depressive patients resistant to serotonin reuptake inhibitors. Arch Gen Psychiatry. 1999;56:375–379.CrossRefGoogle ScholarPubMed
23.Thompson, C. Mirtazapine versus selective serotonin reuptake inhibitors. J Clin Psychiatry. 1999;60(suppl 17):18–22.Google ScholarPubMed
24.Haddjeri, N, Blier, P, de Montigny, C. Effects of long-term treatment with the α2-adrenoceptor antagonist mirtazapine on 5-HT neurotransmission. Naunyn Schmiedebergs Arch Pharmacol. 1997;355:20–29.CrossRefGoogle Scholar
25.Delgado, PL, Moreno, F. Role of norepinephrine in depression. J Clin Psychiatry. 2000;61(suppl 1):5–12.Google ScholarPubMed
26.Debonnel, G, Gobbi, G, Turcotte, J, et al.Comparative study of the therapeutic effects of α2-adrenergic antagonism, serotonin reuptake inhibition and their combination in major depression. Int Neuropsychopharmacol. 2000;3(suppl 1):S37.Google Scholar
27.Besson, A, Haddjeri, N, Blier, P, de Montigny, C. Effects of the co-administration of mirtazapine and paroxetine on serotonergic neurotransmission in the rat brain. Eur Neuropsychopharmacol. 2000;10:177–188.CrossRefGoogle ScholarPubMed
28.Paykel, ES, Ramana, R, Cooper, Z, Hayhurst, H, Kerr, J, Barocka, A. Residual symptoms after partial remission: an important outcome in depression. Psychol Med. 1995:25:1171–1180.CrossRefGoogle ScholarPubMed
29.Judd, LL, Paulus, MJ, Schettler, PJ, et al.Does incomplete recovery from first lifetime major depressive episode herald a chronic course of illness? Am J Psychiatry. 2000:157;1501–1504.CrossRefGoogle Scholar
30.Rouillon, F, Gorwood, P. The use of lithium to augment antidepressant medication. J Clin Psychiatry. 1998;59(suppl 5):32–39.Google ScholarPubMed
31.Blier, P, de Montigny, C. Short-term lithium administration enhances serotonergic neurotransmission: electrophysiological evidence in the rat CNS. Eur J Pharmacol. 1985;113:69–77.CrossRefGoogle ScholarPubMed
32.Nelson, JC. Synergistic effects of serotonergic and noradrenergic antidepressants. Int Clin Neuropsychopharmacol. 1998;1(suppl 1):17.Google Scholar
33.Dursun, SM, Devarajan, S. Reboxetine plus citalopram for refractory depression not responding to venlafaxine: possible mechanisms. Psychopharmacology. 2001;153:497–498.CrossRefGoogle Scholar
34.Carpenter, LL, Leon, Z, Yasmin, S, et al.Mirtazapine augmentation in the treatment of refractory depression. J Clin Psychiatry. 1999;11:81–86.Google Scholar
35.Dong, J, Blier, P. Modification of norepinephrine and serotonin, but not dopamine, neuronal firing by bupropion treatment. Psychopharmacology. 2001;155:52–57.CrossRefGoogle Scholar
36.Mischoulon, D, Nierenberg, AA, Kizilbash, L, Rosebaum, JF, Fava, M. Strategies for managing depression refractory to selective serotonin inhibitor treatment: a survey of clinicians. Can J Psychiatry. 2000;45:476–481.CrossRefGoogle ScholarPubMed
37.Joffe, RT, Schuller, DR. An open study of buspirone augmentation of serotonin reuptake inhibitors in refractory depression. J Clin Psychiatry. 1993;54:269–271.Google ScholarPubMed
38.Bouwer, C, Stein, DJ. Buspirone is an effective augmenting agent of serotonin selective re-uptake inhibitors in severe treatment-refractory depression. S Afr Med J. 1997;87:534–537.Google ScholarPubMed
39.Dimitriou, EC, Dimitriou, CE. Buspirone augmentation of antidepressant therapy. J Clin Psychopharmacol. 1998;18:465–469.CrossRefGoogle ScholarPubMed
40.Debonnel, , Blier, P, St-André, É, et al.Comparison of the effect of low and high doses of venlafaxine on serotonin and norepinephrine reuptake processes in patients with major depression and healthy volunteers. Int Neuropsychopharmacol. 1998;1(suppl 1):17.Google Scholar
41.Poirier, MF, Boyer, P. Venlafaxine and paroxetine in treatment-resistant depression. Double-blind, randomized comparison. Br J Psychiatry. 1999;175:12–16.CrossRefGoogle Scholar
42.Lavori, PW, Rush, AJ, Wisniewski, SR, et al.Strengthening clinical effectiveness trails: equipoise-stratified randomization. Biol Psychiatry. 2001;52:792–801.CrossRefGoogle Scholar
43.Kirby, LG, Rice, KJ, Valentino, RJ. Effects of corticotropin-releasing factor on neuronal activity in the serotonergic dorsal raphe nucleus. Neuropsychopharmacology. 2000;22:148–162.CrossRefGoogle ScholarPubMed
44.Haddjeri, N, Blier, P. Sustained blockade of neurokinin-I receptors enhances serotonin neurotransmission. Biol Psychiatry. 2001;50:191–199.CrossRefGoogle Scholar