Treatment and response in refractory depression: results from a specialist affective disorders service.
BACKGROUND
The best treatment approaches for chronic severe refractory depression remain uncertain. This study aimed to identify short-term outcome and most successful somatic treatments of severe refractory depressives referred to an affective disorders service.


METHODS
Patients with chronic refractory depression referred to a specialist affective disorders service over a 10-year period were studied. Using detailed case records of the index episode, courses of treatment and outcome were examined.


RESULTS
Patients were predominantly middle-aged females with few prior episodes but long index episodes. Patients received higher antidepressant doses and more combinations on the specialist service. Very-high-dose antidepressants (tricyclics, velafaxine or tricyclic--MAOI combinations), usually augmented with lithium and often combined with ECT, were the most effective somatic treatments. Most subjects improved substantially, but few reached premorbid levels.


CONCLUSIONS
The study was retrospective. Treatment courses were sequential rather than random.


CONCLUSIONS
Refractory depression is responsive to vigorous somatic therapy, although most patients continue with some symptoms.
Kennedy
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Department of Psychiatry, University of Cambridge, UK. N.Kennedy@iop.kcl.ac.uk
Paykel
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ES
D000293:Adolescent; D000328:Adult; D000928:Antidepressive Agents / Q000627:therapeutic use*; D003131:Combined Modality Therapy; D003866:Depressive Disorder / Q000175:diagnosis / Q000628:therapy*; D004305:Dose-Response Relationship, Drug; D004359:Drug Therapy, Combination; D004565:Electroconvulsive Therapy; D004739:England; D005260:Female; D005500:Follow-Up Studies; D006785:Hospitals, University; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D008884:Milieu Therapy; D017063:Outcome Assessment, Health Care; D010343:Patient Admission; D011567:Psychiatric Department, Hospital; D011613:Psychotherapy; D012017:Referral and Consultation; D013038:Specialization
D000928:Antidepressive Agents