How Much Do You Know About Pharmacotherapy for Treatment-Resistant Depression?

What is the first-line treatment for treatment-resistant depression?

What is the second-line treatment for treatment-resistant depression?

What are the potential uses of ketamine and esketamine in treating major depression?

What is the treatment of last resort for treatment-resistant depression?

Why do clinicians generally avoid complex medication regimens?

What happens if numerous standard treatments fail in treating depression?

What is the recommended approach when selecting drugs for treatment-resistant depression?

What is the efficacy of different antidepressants for treating treatment-resistant depression?

What is the balance of efficacy and tolerability among augmentation agents for treating treatment-resistant depression?

Pharmacotherapy for Treatment-Resistant Depression

Treatment-refractory unipolar major depression can be treated with antidepressant monotherapy or in combination with another drug.
The choice of drug begins with those that have not been previously used for the current depressive episode.
The efficacy of different antidepressants is generally comparable, and drug selection is based on safety and adverse effects.
Selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs) are the first-line antidepressants.
Second-generation antipsychotics have the best balance of efficacy and tolerability among augmentation agents, followed by lithium and a second antidepressant from a different class.
Intravenous ketamine and intranasal esketamine can also be useful for treatment-refractory depression.
The combination of a tricyclic antidepressant and a monoamine oxidase inhibitor (MAOI) is a treatment of last resort due to potential life-threatening drug interactions.
The MAOI is added after a failed trial of tricyclic monotherapy, and the dose for each drug is comparable to the dose used for monotherapy.
Clinicians generally avoid complex medication regimens due to the lack of data supporting their utility and cumulative side effects.
Lack of response to numerous standard treatments may lead to prescribing multiple concomitant medications (≥4 psychotropic drugs).
Second-generation antipsychotics have the best balance of efficacy and tolerability among augmentation agents, particularly in combination with first-line antidepressants such as SSRIs and SNRIs.
The role of ketamine and esketamine in treating major depression, as well as their administration, efficacy, and adverse effects, are discussed separately.

Test your knowledge on pharmacotherapy for treatment-resistant depression with this informative quiz. Learn about the different antidepressants and augmentation agents used for this condition, including their efficacy, safety, and adverse effects. Explore the role of intravenous ketamine and intranasal esketamine in treating depression and the potential risks of combining certain drugs. Take this quiz to enhance your understanding of treatment options for depression that do not respond to standard treatments.