Pharmacotherapy for treatment-resistant depression

Abstract

The most important goal of acute treatment of a depressive disorder is complete freedom from symptoms (remission), because residual symptoms lead to lower functioning and a poorer prognosis. This goal is often not achieved despite several treatment steps. In these patients, different causes, such as inadequate pharmacotherapy, must be systematically investigated to establish a diagnosis of treatment-resistant depression (TRD). Pharmacotherapy occupies a central role in its treatment. There are still too few randomized controlled trials (RCTs) on the sometimes very complex pharmacotherapy of TRD, so clinical decisions often rely on experiential knowledge, case reports, and uncontrolled studies. Nevertheless, there are several noteworthy new developments, which are summarized and evaluated on an evidence-based basis in this article. Before that, we provide an overview of the most important definitions, epidemiological data, diagnostic measures, and options for optimizing treatment; finally, we take a critical look at the present and future development of antidepressant agents.