Update on the treatment for refractary depression

Abstract

Background:

Mayor Depression affects 340 millions of people in the world 16.2% of risk of life prevalence, 2/3 are women. A refractary depression is the one that does not respond to a well found treatment in a period of time (usually around 8 weeks). It is associated to a higher rate of suicide, 15% higher rate of suicidal thoughts and actions, 33%, which means a worse prognosis. Higher costs; they visit the doctor three times as much as people who are not depressed.

Methods:

we have analysed the main therapeutic reports on refractary depression.

Results:

ECT, may be effective if it is administrated acutely, but results tend to be poor if it is used for a long period of time. The STAR D report (Rush, 2006) showed that 25% of the patients improved as they were given a different antidepressant

The potentation of citalopram with bupropion or buspirone may also be useful (Madhulkar, 2006); combinations of antidepressants with some atypical antipsychotics have given good results (Nemeroff, 2004).

Fluoxetina, olanzapina or a combination of both were effective on a 60% of patients with a refractary depression (Shelton, 2001). Bolder I and II reports showed the effectiveness of using quetiapina. We introduce here the potential mechanisms of action of some atypical antipsychotics in refractary depression (improvement on the serotoninergic transmission, a blockade of the 5HT2 postsinaptic receptors, a release of dopamine in the prefrontal cortex).

Conclusion:

The polyfarmacy is common. It is unknown which treatment or combination is better.