Financial disclosures As discussed in Chapter 1 , it is helpful to define treatment-resistant depression (TRD). Although one defines treatment resistance, it is clear that this is a very significant clinical problem. We now know from multiple randomized controlled clinical…
Overview The problem of nonresponse to antidepressant medications is essentially as old as this area of therapeutics: Even during the 1960s and 1970s, it was known that the likelihood of response to a tricyclic antidepressant (TCA) was far from certain,…
Introduction Despite the availability of many therapeutic strategies, the optimal treatment of depression remains a major challenge. The overall effectiveness of antidepressants remains limited, and in almost 30%–50%, the response to treatment will be insufficient or absent ( ; ).…
Introduction Oral irreversible inhibitors of the intracellular enzyme, monoamine oxidase, have been in clinical use for over 60 years. As a group, they constitute the oldest class of antidepressants. The monoamine oxidase inhibitors (MAOIs) were developed decades ago out of…
Introduction As a group, the tricyclic antidepressants (TCAs) comprise the second-oldest class of antidepressants, beginning with the serendipitous discovery in the late 1950s that imipramine, investigated initially for its sedative properties, was effective for patients with severely depressed mood, marked…
Disclosures LCB is a stockholder and former employee of Myriad Genetics, former employee and current consultant to Tempus Labs, Principal Consultant for Great Scott! Consulting, founding member of Pharmacogenetics Research Network (PGRN), and member of the Clinical Pharmacogenetics Implementation Consortium…
Introduction An algorithm is a stepwise solution used for problem solving. In medicine, the clinical algorithm, most commonly represented as a flow chart, is used in clinical decision-making processes to address diagnosis and treatment ( ). Since the 1990s, many…
Introduction This is an exciting time in the field of psychiatry. The advent of rapid-acting antidepressants (ADs) like ketamine has sparked a paradigm shift in how we think about the biological basis of treatment-resistant depression (TRD) and has inspired creative…
Introduction Multiple treatment modalities are effective for major depressive disorder (MDD), including medications, certain psychotherapies, and brain stimulation approaches such as electroconvulsive therapy (ECT) or repetitive transcranial magnetic stimulation (rTMS). However, treatment resistance, that is lack of full symptom remission…
Introduction Depression affects more than 264 million people worldwide ( ), making it one of the most prevalent of all medical conditions ( ). The sheer prevalence of depression is troubling, in and of itself. It is a chronic, relapsing…