Managing Treatment Resistant Depression

Managing Treatment-Resistant Depression: Road to Novel Therapeutics defines TRD for readers, discussing the clinical and epidemiological predictors, economic burden and neurobiological factors. In addition, staging methods for treatment resistance are fully covered in this book, including serotonin specific reuptake inhibitors, serotonin norepinephrine reuptake inhibitors, other classes of antidepressants, including tricyclic antidepressants and monoamine oxidase inhibitors, augmentation strategies, and newer antidepressant treatments like ketamine and esketamine. In addition, evidence supporting the use of psychotherapies and neuromodulation strategies are also reviewed. Written by top experts in the field, this book is the first of its kind to review all methods of treatment for TRD. Defines Treatment-Resistant Depression and Staging Treatment Intensity Includes Treatment-Resistant Depression options for children, adolescents, geriatrics, during pregnancy, and during post-partum and menopause transitions Discusses the use of Ketamine and Esketamine for treatment-resistant depression

Treatment-resistant Depress 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.

Although there are a variety of textbooks and manuals of psychiatric disorders, few have focused on the management of treatment-resistant patients. Those that exist have largely focused on treatment-resistant depression and even these are now largely outdated. Because psychiatrists and other mental health care professionals increasingly manage patients who fail treatment from family practitioners and other non-psychiatric specialists, a single practical volume summarizing the evidence-based medicine as well as the art of managing treatment-resistant patients is a much needed volume for practitioners, psychiatry residents and other mental health workers. Most importantly, both psychopharmacological and psychotherapeutic interventions will be included, a shortcoming of many previous volumes. "Management of Treatment Resistant Major Psychiatric Disorders" contains chapters authored by leaders in the field on the management of the major treatment resistant psychiatric disorders.

This unique book presents the treatment "roadmap" implemented by the University of Michigan Comprehensive Depression Center's Treatment Resistant Depression Program, step-by-step guidance that has long eluded clinicians, patients, and their families. Writing across discipline, modality, lifespan, and patient demographics, the authors have compiled the most current thinking on TRD and distilled it into a highly readable, imminently practical, and brilliantly organized source of hope. The authors believe that early intervention is critical, and they advocate strategies for renewed focus on identifying youths who are at risk or already symptomatic. Similarly, they devote chapters to special populations such as pregnant women, older people, and those with comorbidities. Perhaps most useful to patients and their families, the book has a strong self-care orientation, emphasizing the importance of exercise, nutrition, and healthy sleep guidelines. Patients who are actively engaged in managing their disease often have better outcomes. Treatment Resistant Depression is frequently a lifetime diagnosis. The book acknowledges that fact and offers a systematic course of treatment grounded in evidence-based research that is current and comprehensive. Treatment Resistant Depression: A Roadmap for Effective Care offers a new way of conceptualizing an old enemy, and should prove to be an indispensable weapon in the battle.

As many as 35-40% of patients afflicted with Major Depressive Disorder (MDD) are treatment resistant, a situation that places a massive emotional and financial burden on society and challenges the mental health profession to develop new treatment paradigms and practices. Even the most astute clinicians can be frustrated when treatment options fail to be effective or work for only a brief time, leaving them to wonder what course to pursue next. Treatment Resistant Depression: A Roadmap for Effective Care gives clinicians and their patients what they need most desperately: a sequence of steps that reflect state-of-the-art diagnostic procedures and integrates all evidence-based treatment modalities -- in short, a roadmap to wellness and recovery. Based primarily on the experiences of the authors, all of whom are leading researchers and/or clinicians in Treatment Resistant Depression and affiliated with the University of Michigan Comprehensive Depression Center, the book also draws upon the clinical research advances and treatment innovations of programs around the world. Although the book's step-by-step organization is clear and easy to follow, its coverage, scope, and level of sophistication are anything but simplified. This book Is comprehensive, addressing treatment options, including psychopharmacotherapy, psychotherapy, neuromodulation (ECT, transcranial magnetic stimulation, deep brain stimulation, vagus nerve stimulation), exercise, nutrition, self-management approaches to enhance adherence, behavioral sleep programs, and others Addresses treatment resistant depression across the lifespan, reflecting the diverse demographics of depression, which knows no age, gender, or socioeconomic status Emphasizes the authors' commitment to early intervention and provides techniques for identifying young people who are at risk for developing depression or already expressing symptoms of the disease Recognizes the chronicity of depression, rather than focusing on only the acute stage, and in this way allows for more effective treatment over the patient's lifetime Introduces self-management as playing a critical role in the patient's prognosis, engagement, adherence to clinical steps that help maintain recovery, and self-esteem Promotes the development of new, personalized, and predictive biomarkers to target treatment more effectively. Designed to be useful across disciplines and treatment modalities, the book includes a multitude of tables, graphs, and learning aids that will benefit students, instructors, and clinicians. At the same time, the book promises to be a valuable resource for patients and their families, since Treatment Resistant Depression is both difficult to live with and little understood. No other book offers so much practical guidance, sound research and hope.

Ketamine for Treatment-Resistant Depression: Neurobiology and Applications provides a simple, evidence-based overview for neuropsychiatrists and translational researchers on this medication, its mechanisms of actions, eligibility of patients for treatment, and the preparation and implementation of ketamine clinics. Provides efficacy research on ketamine as a treatment for depression Identifies best practices for clinical use, both long-term and acute Discusses the molecular mechanisms and neurobiology of action

The Advances in Pharmacology series presents a variety of chapters from the best authors in the field. Includes the authority and expertise of leading contributors in pharmacology Presents the latest release in the Advances in Pharmacology series

This book brings together an international group of clinicians and researchers from a broad swath of inter-related disciplines to offer the most up-to-date information about clinical and preclinical research into ketamine and second-generation “ketamine-like” fast-acting antidepressants. Currently available antidepressant medications act through monoaminergic systems, are ineffective for many individuals suffering from depression, and are associated with a delayed onset of peak efficacy of several months. The unexpected emergence of ketamine, an anesthetic N-methyl-D-aspartate (NMDA) receptor antagonist, as a rapid-acting antidepressant has reinvigorated CNS drug discovery research and catalyzed investigation in patient populations historically ignored in antidepressant drug development programs, particularly treatment-resistant patients and those with suicidality. Recent industry and academic research efforts have coalesced to explore NMDA receptor and glutamatergic molecular targets that lack ketamine’s psychotomimetic side effects and abuse liability but retain its rapid onset of efficacy. However, many fundamental questions remain regarding the neurobiological mechanisms underlying ketamine’s rapid antidepressant effects and the puzzling persistence of benefits observed in some patients following a single dose. This book examines how insights from these studies are forging new conceptual models of the neurobiology of stress-related affective, anxiety, and addictive disorders and the nature of treatment resistance. It also discusses how ketamine’s rapid antidepressant effects provide a scientific platform to facilitate innovation in clinical trial designs pertaining to patient selection, choice of control group, outcome measures, and dose-optimization. This book brings together data and insights from this rapidly expanding and extraordinarily promising field of study. Readers will be able to extract integrated themes and useful insights from the material contained in these diverse chapters and appreciate the paradigm-shifting contributions of ketamine to modern psychiatry and clinical neuroscience research.