Treatment‐resistant Depression
About this book
Successful management of patients with treatment-resistant depression requires a thorough understanding of the biological basis for both the depression and its failure to respond to standard treatments. This book clearly and succinctly summarizes the latest scientific research and its applications in clinical practice.
A first step is a clear definition of what constitutes treatment-resistant depression so that clinical trials and other studies are using common criteria, enabling comparison and meta-analysis of their outcomes. The opening chapter reviews definitions and predictors of treatment-resistant depression originating from different fields and discusses their usefulness in clinical practice and clinical research. The next chapter proposes a new definition, adapting terminology from medicine.
Biological classification requires identification of genetic risk factors and gene variants have been identified as accounting for 50% of the variance in the clinical outcomes of antidepressant treatments. Chapter 3 describes several genes already associated with treatment-resistant depression and, while further work is needed to translate findings into clinical recommendations, suggests that genetic prediction of treatment resistance could become a widespread clinical reality within a few years.
Most patients with treatment-resistant depression will be treated pharmacologically, so three chapters review the latest evidence for pharmacological best practice in switching strategies for antidepressants, the role of antipsychotics and augmentation strategies to complement lithium.
There are two major alternatives to pharmacotherapy: neuromodulation and psychotherapy. The brain intervention chapter summarizes clinical research and experience with electroconvulsive therapy, transcranial magnetic stimulation, vagus nerve stimulation, deep brain stimulation and magnetic seizure therapy. The final chapter reviews the literature pertaining to the effectiveness of various forms of psychotherapy in patients who have not responded to antidepressant pharmacotherapy, explaining that patients who have not responded to one or two trials of antidepressant medication have a 30%-50% chance of responding to a focused psychotherapy. It proposes indications for psychotherapy in treatment-resistant depression and summarizes general therapeutic principles.
Essential reading for all psychiatrists managing patients with this distressing disorder.
Reviews
“After all, this book is recommended for the young psychiatrist, who wants to read an easy introduction to the fascinating world of treatment of resistant depression.” (Acta Psychiatrica Scandinavica, 9 November 2013)
“This is a monograph, which could be of great interest to psychiatrists managing patients with TRD. The chapters are written clearly, and the references are comprehensive and up-to-date.” (Human Psychopharmacology: Clinical & Experimental, 6 November 2013)
“The editors should be congratulated for accomplishing the amazing feat of presenting so much information in such a compact book. With an investment of just a few hours, readers can be updated on a very complicated subject . . . The editors should be commended on detailing a variety of treatment options, including nonpharmacological options, which other books fail to emphasize.” (Doody’s, 23 August 2013)
Author Bios
Professor Montgomery was Professor of Psychiatry at Imperial College, University of London until his retirement in 1996 when he became Emeritus Professor of Psychiatry. He has great breadth of experience in the field of psychotropic medicine with seminal work in depression, anxiety disorders, suicide prevention and schizophrenia. He has published 26 books and more than 400 papers. Professor Montgomery is editor of International Clinical Psychopharmacology and was editor of European Neuropsychopharmacology for 20 years. He also serves on the editorial board of numerous scientific journals.