The literature we reviewed shows that augmentation methods using non-antidepressant medications in the treatment of TRD have been well documented. The use of SSRIs like fluoxetine with either desipramine (TCA), trazodone, or mirtazapine has also been shown to be efficacious. It must be noted, however, that this three-drug combination is not well tolerated by most patients, and a TCA/MAOI combination is generally not recommended. The combination of a TCA and an SSRI has been found to be more effective than either drug class alone, and the addition of moclobemide (MAOI) to the TCA and SSRI combination is even more effective. These drugs can be used as monotherapy or in combination for more severe cases. Some of the most used antidepressants include selective serotonin reuptake inhibitors (SSRIs), serotonin, norepinephrine reuptake inhibitors (SNRIs), monoamine oxidase inhibitors (MAOIs), and tricyclic antidepressants (TCAs). The treatment options discussed in this literature review are not an exhaustive list. The treatment options for TRD are numerous and include both pharmacologic and non-pharmacologic therapies. It has been found that TRD is slightly more prevalent among women and effects patients between 36 and 64 years of age. It is estimated that 10-29% of patients diagnosed with MDD also meet the criteria for TRD. Currently, the most widely accepted definition of TRD is a failure to achieve clinical improvement of depressive symptoms following a trial of at least two antidepressant medications from two different pharmacological classes at adequate dosage (which may vary from patient to patient), duration (at least four to eight weeks), and compliance. The term “treatment-resistant depression (TRD)” was first used in 1974 following the World Health Organization conference on major depressive disorder (MDD). It has been reported that only 29-46% of patients diagnosed with depression and treated with antidepressant monotherapy achieve clinical improvement of their symptoms, creating a clinical problem when trying to treat patients suffering from depression. To our knowledge, a case of TRD responding so strongly to Adderall after failing to respond to such drastic pharmacologic measures, as well as TMS, has not been reported.Īccording to the National Institute of Mental Health, an estimated 17.3 million Americans over the age of 18 experienced at least one major depressive episode in 2017. We will review the literature that currently exists on treatment-resistant depression and the treatment options for TRD, as well as present our case. This case is unique as this patient has recently experienced significant relief of her depressive symptoms using amphetamine and dextroamphetamine (Adderall) as an adjunct to her antidepressant therapy. Transcranial magnetic stimulation provided a brief relief of symptoms in this patient however, relapse occurred a few months later. This patient failed to experience consistent relief of symptoms using different antidepressant monotherapies as well as different combinations of therapies. Here we present a 62-year-old female diagnosed with severe major depressive disorder that meets the criteria for treatment-resistant depression. Although both men and women can be effected by TRD, our review found a slight predominance in older women. Some sources lower the threshold to failure of one medication, but most support two medications. Although there is some non-consensus on a definition for TRD, the most widely accepted definition of TRD is a failure to achieve clinical improvement of depressive symptoms following a trial of two or more antidepressant medications from two or more different pharmacological classes at adequate dosage, duration, and compliance. There is much debate over a precise definition of treatment-resistant depression (TRD) as well as the method of staging this illness.
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