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Refractory depression in late life: a review of treatment options

Published online by Cambridge University Press:  17 November 2008

RC Baldwin*
Affiliation:
Manchester Royal Infirmary, Manchester, UK
*
Central Manchester Healthcare Trust, York House, Manchester Royal Infirmary, Oxford Road, Manchester M13 9BX, UK.

Extract

There seems reasonable, if depressing, agreement from studies of mixed aged subjects and elderly subjects in psychiatric settings that nonresponse or poor response to a course of an antidepressant occurs in at least one-third of depressed patients. The figure may be higher in elderly patients in general and those with poor physical health. The human cost of chronic depression is highlighted in the Medical Outcomes Study. The level of functional impairment and intereference with quality of life associated with depression was comparable with or worse than that of eight major chronic medical conditions, including diabetes, arthritis and severe coronary artery disease. The final tragedy for unremitting depression may of course be suicide.

Type
Psychiatry of old age
Copyright
Copyright © Cambridge University Press 1996

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References

1Katona, CLE, Abou-Saleh, MT, Harrison, DH et al. Placebo-controlled trial of lithium augmentation of fluoxetine and lofepramine. Br J Psychiatry 1995; 166: 8086.CrossRefGoogle ScholarPubMed
2Murphy, E. The prognosis of depression in old age. Br J Psychiatry 1983; 142: 111–19.CrossRefGoogle ScholarPubMed
3Smith, A, Singh, S. Treatment-resistant depression: causes and consequences. Psychiatric Bull 1995; 19: 676–80.CrossRefGoogle Scholar
4Baldwin, RC, Jolley, DJ. The prognosis of depression in old age. Br J Psychiatry 1986; 149: 574–83.CrossRefGoogle ScholarPubMed
5Wells, KB, Stewart, A, Hays, RD et al. The functioning and well-being of depressed patients: results from the Medical Outcomes Study. JAMA 1989; 262: 914–19.CrossRefGoogle ScholarPubMed
6Lehman, HE. Therapy-resistant depressions: a clinical classification. Pharmakopsychiatr Neuropsychopharmacol 1974; 7: 156–63.CrossRefGoogle Scholar
7Flint, AJ. Augmentation strategies in geriatric depression. Int J Ceriatr Psychiatry 1995; 10: 137–46.CrossRefGoogle Scholar
8Guscott, R, Grof, P. The clinical meaning of refractory depression: a review for the clinician. Am J Psychiatry 1991; 148: 695704.Google ScholarPubMed
9Bridges, PK, Hodgkiss, AD, Malzia, AL. Practical management of treatment-resistant affective disorders. Br J Hosp Med 1995; 54: 501506.Google ScholarPubMed
10Quitkin, FM, Rabkin, JG, Ross, D, McGrath, PJ. Duration of antidepressant treatment: what is an adequate trial? Arch Gen Psychiatry 1984; 41: 238–45.CrossRefGoogle ScholarPubMed
11Georgotas, A, McCue, R. The additional benefit of extending an antidepressant trial past seven weeks in the depressed elderly. Int J Geriatr Psychiatry 1989; 4: 191–95.CrossRefGoogle Scholar
12Shaw, DM. The practical management of affective disorders. Br J Psychiatry 1977; 130: 432–51.CrossRefGoogle ScholarPubMed
13Akiskal, HS. A proposed approach to chronic and ‘resistant’ depressions: evaluation and treatment. J Clin Psychiatry 1985; 46: 3236.Google ScholarPubMed
14Nolen, WA, van de, Putte, Dijken, WA et al. Treatment strategy in depression 1. Nontricyclic. and selective reuptake inhibitors in resistant depression: a double-blind partial crossover study on the effects of oxaprotiline and fluvoxamine. Acta Psychiatr Scand 1988; 78: 668–75.CrossRefGoogle Scholar
15Evans, ME. Depression in elderly physically ill inpatients: a 12-months prospective study. Int J Geriatr Psychiatry 1992; 8: 587–92.CrossRefGoogle Scholar
16Roose, SP, Classman, AH, Attia, E, Woodring, S. Comparative efficacy of selective serotonin reuptake inhibitors and tricyclics in the treatment of melancholia. Am J Psychiatry 1994; 151: 1735–39.Google ScholarPubMed
17Georgotas, A, Friedman, E, McCarthy, M et al. Resistant geriatric depressions and therapeutic response to monoamine oxidase inhibitors. Biol Psychiatry 1983; 18: 195205.Google ScholarPubMed
18O'Brien, S, McKeon, P, O'Ryan, M. The efficacy and tolerability of combined antidepressant treatment in different depressive subgroups. Br J Psychiatry 1993; 162: 363–68.CrossRefGoogle ScholarPubMed
19Seth, R, Jennings, AL, Bindman, J, Phillips, J, Bergmann, K. Combination treatment with noradrenalin and serotonin reuptake inhibitors in resistant depression. Br J Psychiatry 1992; 161: 562–65.CrossRefGoogle ScholarPubMed
20Preskorn, SH, Beber, JH, Faul, JC. Serious adverse effects of combining fluoxetine and TCAs [Letter]. Am J Psychiatry 1990; 147: 532.Google Scholar
21Tanum, LH. Combination treatment with antidepressants in refractory depression. Int Clin Psychopharmacol 1994; 9 (suppl 2): 3740.CrossRefGoogle ScholarPubMed
22de Montigny, C, Grunberg, F, Mayer, A, Deschenes, JP. Lithium induces rapid relief of depression in tricyclic antidepressant drug non-responders. Br J Psychiatry 1981; 138: 252–56.CrossRefGoogle ScholarPubMed
23Austin, MPV, Souza, FGM, Goodwin, GM. Lithium augmentation in antidepressant-resistant patients: a quantitative analysis. Br J Psychiatry 1991; 159: 510–14.CrossRefGoogle ScholarPubMed
24Schou, M. Lithium and treatment-resistant depression: a review. Lithium 1990; 1: 38.Google Scholar
25Lafferman, J, Soloman, K, Ruskin, P. Lithium augmentation for treatment-resistant depression. J Geriatr Psychiatry Neurol 1988; 1: 4952.CrossRefGoogle ScholarPubMed
26Finch, EJL, Katona, CLE. Lithium augmentation in the treatment of refractory depression in old age. Int J Geriatr Depress 1989; 4: 4146.CrossRefGoogle Scholar
27van Marwijk, DWJ, Beckker, FM, Nolen, WA, Jensen, PAF, van Nieuwkerk, JF, Hop, WCJ. Lithium augmentation in geriatric depression. J Affect Disord 1990; 20: 217–23.CrossRefGoogle ScholarPubMed
28Seymour, J, Wattis, JP. Treatment-resistant depression in the elderly: three cases. Int Clin Psychopharmacol 1992; 7: 5557.CrossRefGoogle ScholarPubMed
29Zimmer, B, Rosen, J, Thornton, JE, Peral, JM, Reynolds, CF. Adjunctive low-dose lithium carbonate in treatment-resistant depression: a placebo-controlled study. J Clin Psychopharmacol 1988; 8(2): 120–24.Google Scholar
30Flint, AJ, Rifat, SL. A prospective study of lithium augmentation in antidepressant-resistant geriatric depression. J Clin Psychopharmacol 1994; 14: 353–56.CrossRefGoogle ScholarPubMed
31Parker, KL, Mittmann, N, Shear, NH et al. Lithium augmentation in geriatric depressed outpatients: a clinical report. Int J Geriatr Depress 1994; 9: 9951002.CrossRefGoogle Scholar
32Wilson, KCM, Scott, M, Abou-Saleh, M, Burns, R, Copeland, JRM. Long-term effects of cognitive–behavioural therapy and lithium therapy on depression in the elderly. Br J Psychiatry 1995; 167: 653–58.CrossRefGoogle Scholar
33Zusky, PM, Biederman, J, Rosenbaum, JF et al. Adjunct low dose lithium carbonate in treatment-resistant depression: a placebo-controlled study. J Clin Psychopharmacol 1988; 8: 120–24.CrossRefGoogle ScholarPubMed
34Kushnir, SL. Lithium–antidepressant combinations in the treatment of depressed, physically ill geriatric patients. Am J Psychiatry 1986; 143: 378–79.Google ScholarPubMed
35Foster, JR. Use of lithium in elderly psychiatric patients: a review of the literature. Lithium 1992; 3: 7793.Google Scholar
36Stone, K. Mania in the elderly. Br J Psychiatry 1989; 155: 220–24.CrossRefGoogle ScholarPubMed
37Baldwin, RC. Late life depression and structural brain changes: a review of recent magnetic resonance imaging research. Int J Geriatr Psychiatry 1993; 8: 115–23.CrossRefGoogle Scholar
38Prudec, JM, Sackeim, HA, Rifas, S. Medication resistance, response to ECT, and prevention of relapse. Psychiatr Ann 1994; 24: 228–31.CrossRefGoogle Scholar
39Benbow, SB. The role of electroconvulsive therapy in the treatment of depressive illness in old age. Br J Psychiatry 1989; 155: 147–52.CrossRefGoogle ScholarPubMed