Treatment-Resistant Unipolar Depression Treatment - Combined Antidepressant Treatments

Combined Antidepressant Treatments
How should antidepressants be combined and for how long? The term combination strategy in resistant depression typically refers to the addition to an antidepressant of a compound with well-established efficacy as a single agent in the treatment of depression. A typical example of this is the SSRI-TCA combination. When patients do not respond to treatment with a TCA alone, SSRIs in standard doses can be added to a reduced dose of the TCA, but TCA blood levels should be monitored. On the other hand, when patients do not respond to treatment with an SSRI alone, clinicians may initially add TCAs in low dosages from 10 to 25 mg/day without changing the SSRI dose and can raise the TCA dose while monitoring TCA blood levels. Relatively more user-friendly combination strategies involve the simultaneous use of SSRIs with atypical antidepressants such as bupropion, mirtazapine, and nefazodone. Despite the evident risks, MAOIs have been combined with TCAs; the safest approach is to initiate both drugs simultaneously and to gradually raise their doses to standard antidepressant levels. As mentioned before, neither SSRIs (including venlafaxine) nor clomipramine should be combined with MAOIs.

Treatment-Resistant Mood Disorders
Introduction
Treatment-Resistant Unipolar Depression
- Definition
- Phases of Treatment

- Depressive Subtypes and Treatment Response
-- Melancholic Depression
-- Atypical Depression
-- Double Depression
-- Psychotic Depression
-- Depression With Concurrent Psychiatric Illnesses
-- Anxious Depression
-- Depression With Panic Attacks
-- Depression With Anger Attacks
-- Depression With Concurrent Personality Disorders
-- Depression With Concurrent Substance Abuse

- Antidepressant Treatment Options
-- Augmentation Strategies
-- Thyroid augmentation
-- Dopaminergic and stimulant augmentation
-- Buspirone augmentation
-- Venlafaxine augmentation
-- Mirtazapine augmentation
-- Atypical antipsychotic drug augmentation
-- Anticonvulsant drug augmentation
-- Benzodiazepine augmentation
-- Higher-Dose Antidepressants
-- Combined Antidepressant Treatments
-- Combined MAOIs and TCAs
-- Combined SSRIs and TCAs
-- SSRI-nefazodone combination
-- Switching Strategies

- Other Treatment Options

Treatment-Resistant Bipolar Disorder
- Definition
- Subtypes, Other Clinical Factors
- Practical Management
- Treatment of Bipolar Depression
- Treatments to Control Cycling

Conclusions
Multiphase Treatment Strategy for Bipolar Disorder
- Acute Phase
- Continuation Phase
- Discontinuation Phase /Maintenance Phase

Antidepressant and Antimanic Medications
Depression-Focused Psychotherapies
Psychodynamic Psychotherapies
Combined Medication and Psychotherapy
Electroconvulsive Therapy
Light Therapy
Treatment-Resistant Mood Disorders
Treatment of Mood Disorders in the Medically Ill Patient
Strategies and Tactics in the Treatment of Depression

No guidelines exist as to the duration of an adequate trial of a combination strategy. Patients who respond have shown improvement as early as within 24-48 hours and as late as after several weeks. Unfortunately, no longitudinal or double-blind discontinuation studies of responders to combination strategies are available. A reasonable strategy is to test whether the added antidepressant remains necessary for maintaining a response by a trial of discontinuation 16 weeks or more after a response. If the patient experiences a relapse during discontinuation, the discontinued agent can be reinstated.

Treatment-Resistant Unipolar Depression Treatment: Combined MAOIs and TCAs » »

Provided by ArmMed Media
Revision date: July 3, 2011
Last revised: by David A. Scott, M.D.

RELATED STORIES:
Treatment-Resistant Unipolar Depression Treatment - Thyroid augmentation   Treatment-Resistant Unipolar Depression Treatment - SSRI-nefazodone combination   Treatment-Resistant Mood Disorders   Treatment-Resistant Unipolar Depression Treatment - Buspirone augmentation   Treatment-Resistant Unipolar Depression Treatment - Dopaminergic and stimulant augmentation   Treatment of Bipolar Depression   Bipolar Depressive Subtypes, Other Clinical Factors, and Treatment Response   Treatment-Resistant Unipolar Depression Treatment - Combined SSRIs and TCAs   Treatments to Control Cycling   Treatment-Resistant Unipolar Depression   Multiphase Treatment Strategy for Bipolar Disorder   Treatment-Resistant Unipolar Depression Treatment - Combined MAOIs and TCAs   Antidepressant Treatment Options   Treatment-Resistant Bipolar Disorder   Treatment-Resistant Unipolar Depression - Other Treatment Options

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