Psychiatria pre prax 4/2017

Pharmacoresistant depression – what is the next step?

Pharmacoresistant depression (treatment resistant depression, TRD) is associated with a higher suicidal risk of suicides and poor prognosis. Its management is a challenge. Before using the recommended strategies for TRD i.e. switch to another antidepressant, augmentation and combination of antidepressant, we should evaluate the diagnosis, mainly comorbidity and adequacy of previous treatment including adherence. Frequently used strategies such as augmentation and combinations have all disadvantages of polytherapy. An interesting option for TRD is monotherapy with multimodal/multifunctional antidepressants, aiming at several molecular targets with different mechanism of action. Clinical studies in this indication have not been done.

Keywords: pharmacoresistant depression, combination of antidepressants, augmentation, multimodal/multifunctional antidepressants