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      Patient Preference and Adherence (submit here)

      This international, peer-reviewed Open Access journal by Dove Medical Press focuses on the growing importance of patient preference and adherence throughout the therapeutic process. Sign up for email alerts here.

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      Treatment-resistant depression: therapeutic trends, challenges, and future directions

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          Abstract

          Background

          Patients with major depression respond to antidepressant treatment, but 10%–30% of them do not improve or show a partial response coupled with functional impairment, poor quality of life, suicide ideation and attempts, self-injurious behavior, and a high relapse rate. The aim of this paper is to review the therapeutic options for treating resistant major depressive disorder, as well as evaluating further therapeutic options.

          Methods

          In addition to Google Scholar and Quertle searches, a PubMed search using key words was conducted, and relevant articles published in English peer-reviewed journals (1990–2011) were retrieved. Only those papers that directly addressed treatment options for treatment-resistant depression were retained for extensive review.

          Results

          Treatment-resistant depression, a complex clinical problem caused by multiple risk factors, is targeted by integrated therapeutic strategies, which include optimization of medications, a combination of antidepressants, switching of antidepressants, and augmentation with non-antidepressants, psychosocial and cultural therapies, and somatic therapies including electroconvulsive therapy, repetitive transcranial magnetic stimulation, magnetic seizure therapy, deep brain stimulation, transcranial direct current stimulation, and vagus nerve stimulation. As a corollary, more than a third of patients with treatment-resistant depression tend to achieve remission and the rest continue to suffer from residual symptoms. The latter group of patients needs further study to identify the most effective therapeutic modalities. Newer biomarker-based antidepressants and other drugs, together with non-drug strategies, are on the horizon to address further the multiple complex issues of treatment-resistant depression.

          Conclusion

          Treatment-resistant depression continues to challenge mental health care providers, and further relevant research involving newer drugs is warranted to improve the quality of life of patients with the disorder.

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          Author and article information

          Journal
          Patient Prefer Adherence
          Patient Prefer Adherence
          Patient preference and adherence
          Dove Medical Press
          1177-889X
          2012
          01 May 2012
          : 6
          : 369-388
          Affiliations
          Medical College, King Saud Bin Abdulaziz University for Health Sciences, King Abdulaziz Medical City, Riyadh, Kingdom of Saudi Arabia
          Author notes
          Correspondence: Khalid Saad Al-Harbi, Medical College, King Saud Bin Abdulaziz, University for Health Sciences, King Abdulaziz Medical City, Riyadh, Kingdom of Saudi Arabia, Tel +966 1252 0088, Email ks-alharbi@ 123456hotmail.com
          Article
          ppa-6-369
          10.2147/PPA.S29716
          3363299
          22654508
          b90f68aa-71a8-49b8-ab2c-e42928056859
          © 2012 Al-Harbi, publisher and licensee Dove Medical Press Ltd.

          This is an Open Access article which permits unrestricted noncommercial use, provided the original work is properly cited.

          Categories
          Review

          Medicine
          therapeutic options,biomarkers,treatment-resistant depression,antidepressants,somatic therapies

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