N Kennedy1, E S Paykel. 1. Department of Psychiatry, University of Cambridge, UK. N.Kennedy@iop.kcl.ac.uk
Abstract
BACKGROUND: The best treatment approaches for chronic severe refractory depression remain uncertain. This study aimed to identify short-term outcome and most successful somatic treatments of severe refractory depressives referred to an affective disorders service. METHODS: Patients with chronic refractory depression referred to a specialist affective disorders service over a 10-year period were studied. Using detailed case records of the index episode, courses of treatment and outcome were examined. RESULTS: Patients were predominantly middle-aged females with few prior episodes but long index episodes. Patients received higher antidepressant doses and more combinations on the specialist service. Very-high-dose antidepressants (tricyclics, velafaxine or tricyclic--MAOI combinations), usually augmented with lithium and often combined with ECT, were the most effective somatic treatments. Most subjects improved substantially, but few reached premorbid levels. LIMITATIONS: The study was retrospective. Treatment courses were sequential rather than random. CONCLUSIONS: Refractory depression is responsive to vigorous somatic therapy, although most patients continue with some symptoms.
BACKGROUND: The best treatment approaches for chronic severe refractory depression remain uncertain. This study aimed to identify short-term outcome and most successful somatic treatments of severe refractory depressives referred to an affective disorders service. METHODS:Patients with chronic refractory depression referred to a specialist affective disorders service over a 10-year period were studied. Using detailed case records of the index episode, courses of treatment and outcome were examined. RESULTS:Patients were predominantly middle-aged females with few prior episodes but long index episodes. Patients received higher antidepressant doses and more combinations on the specialist service. Very-high-dose antidepressants (tricyclics, velafaxine or tricyclic--MAOI combinations), usually augmented with lithium and often combined with ECT, were the most effective somatic treatments. Most subjects improved substantially, but few reached premorbid levels. LIMITATIONS: The study was retrospective. Treatment courses were sequential rather than random. CONCLUSIONS:Refractory depression is responsive to vigorous somatic therapy, although most patients continue with some symptoms.
Authors: Joseph R Calabrese; David J Muzina; David E Kemp; Gary S Sachs; Mark A Frye; Thomas R Thompson; David Klingman; Michael L Reed; Robert M A Hirschfeld Journal: MedGenMed Date: 2006-08-15