Cited by 796Treatment of Major DepressionElectroconvulsive Therapy StudiesTranscranial Magnetic Stimulation Studies

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Treatment-resistant depression: therapeutic trends, challenges, and future directions

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Al-harbi·2012·Patient Preference and Adherence

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Abstract

BACKGROUND: Patients with major depression respond to antidepressant treatment, but 10%-30% of them do not improve or show a partial response coupled with functional impairment, poor quality of life, suicide ideation and attempts, self-injurious behavior, and a high relapse rate. The aim of this paper is to review the therapeutic options for treating resistant major depressive disorder, as well as evaluating further therapeutic options. METHODS: In addition to Google Scholar and Quertle searches, a PubMed search using key words was conducted, and relevant articles published in English peer-reviewed journals (1990-2011) were retrieved. Only those papers that directly addressed treatment options for treatment-resistant depression were retained for extensive review. RESULTS: Treatment-resistant depression, a complex clinical problem caused by multiple risk factors, is targeted by integrated therapeutic strategies, which include optimization of medications, a combination of antidepressants, switching of antidepressants, and augmentation with non-antidepressants, psychosocial and cultural therapies, and somatic therapies including electroconvulsive therapy, repetitive transcranial magnetic stimulation, magnetic seizure therapy, deep brain stimulation, transcranial direct current stimulation, and vagus nerve stimulation. As a corollary, more than a third of patients with treatment-resistant depression tend to achieve remission and the rest continue to suffer from residual symptoms. The latter group of patients needs further study to identify the most effective therapeutic modalities. Newer biomarker-based antidepressants and other drugs, together with non-drug strategies, are on the horizon to address further the multiple complex issues of treatment-resistant depression. CONCLUSION: Treatment-resistant depression continues to challenge mental health care providers, and further relevant research involving newer drugs is warranted to improve the quality of life of patients with the disorder.

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“Additional efforts to more effectively treat people with TRD have involved interventions such as magnetic seizure therapy (MST), vagal nerve stimulation (VNS), deep brain stimulation (DBS), transcranial magnetic stimulation (TMS), and/or electro-convulsive therapy (ECT) [22–24].”
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“Moreover, up to 30% of depressed patients are resistant to traditional Frontiers in Behavioral Neuroscience | www.frontiersin.org 1 October 2018 | Volume 12 | Article 240 antidepressant therapies (Joffe et al., 1996; Al-Harbi, 2012).”
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“Major depressive disorder (MDD) is a devastating psychiatric condition characterized by a low mood, loss of interest or pleasure in daily life and high suicide rates (Al-Harbi, 2012).”
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“In addition, only about one-third of MDD patients achieve complete remission after a single antidepressant trial (Trivedi et al., 2006) and around 10–30% of patients are treatment-resistant (Al-Harbi, 2012).”
Background
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“Additionally, treatment resistance occurs generally in approximately 30% of treated MDD patients [41]; therefore, improved TRD management is warranted that includes the effect of specific targeted treatment strategies encompassing psychological therapies.”
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“Approximately 30% of depression patients have resistance to treatment with antidepressants [1, 2].”
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“This leads to sustained human suffering, accumulation of side-effects, and substantial economic costs [5, 6].”
Background

Authors: Al-harbi
Venue: Patient Preference and Adherence
Publisher: Informa UK Limited
Published: 2012-05
Volume: 6
Pages: 369
ISSN: 1177-889X (ISSN-L)
DOI: 10.2147/ppa.s29716
PMC: PMC3363299
OpenAlex: W2016292245
Cited by: 796
References: 155
Citations by year: 2026: 75 · 2025: 76 · 2024: 104 · 2023: 95 · 2022: 107 · 2021: 91 · 2020: 63 · 2019: 56 · 2018: 38 · 2017: 33 · 2016: 18 · 2015: 15 · 2014: 14 · 2013: 6 · 2012: 3
FWCI: 8.94
Type: journal article
Language: en
Open access: gold
doi.org
Licence: cc-by-nc
creativecommons.org/licenses/by-nc/3.0/ (vor)
Locations: Patient Preference and Adherence (publishedVersion, cc-by-nc)
PubMed Central (publishedVersion)
PubMed (publishedVersion)
Dove Medical Press (Taylor and Francis Group) (submittedVersion, cc-by-nc)
Funders: King Saud bin Abdulaziz University for Health Science
Topics: Health Sciences › Medicine › Pharmacology (medical) › Treatment of Major Depression
Health Sciences › Medicine › Psychiatry and Mental health › Electroconvulsive Therapy Studies
Life Sciences › Neuroscience › Neurology › Transcranial Magnetic Stimulation Studies
Keywords: treatment-resistant depression, major depressive disorder, antidepressant augmentation, antidepressant switching, antidepressant combination therapy, electroconvulsive therapy, repetitive transcranial magnetic stimulation, deep brain stimulation, vagus nerve stimulation, transcranial direct current stimulation, magnetic seizure therapy, psychosocial interventions, relapse

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Treatment-resistant depression: therapeutic trends, challenges, and future directions

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