Nov 15, 2018
Today’s question is: How to manage treatment-resistant
Here is a summary of this episode:
- The first step in the management of treatment-resistant
depression (TRD) is adequate history taking and assessment for
comorbidities and bipolar depression.
- Augmentation is more effective than switching. Adding lithium
is effective particularly in suicidal patients. Modafinil and T3
have been shown to be good add-ons in patients with fatigue.
- Psychosocial interventions such as mindfulness CBT and
behavioral activation have been shown to improve outcomes and
prevent relapse of depression.
- Depression may have an underlying inflammatory component and it
has been found in some studies that patients with raised CRP above
3 mg/dL did better with nortriptyline than with SSRIs.