[Treatment-resistant mood disorders].
OBJECTIVE
Mood disorders are the most prevalent psychiatric disorders. Despite new insights and advances on the neurobiological basis and therapeutic approaches for bipolar disorders and recurrent depression, elevated prevalence of recurrence, persistent sub-syndromal symptoms and treatment resistance are challenging aspects and need to be urgently addressed. The objective of this literature review is to evaluate the current concepts of treatment resistance and refractoriness in mood disorders.


RESULTS
Genetic factors, misdiagnosis, use of inappropriate pharmacological approaches, non-compliance and biological/psychosocial stressors account for dysfunctions in mood regulation, thus increasing the prevalence of refractory mood disorders. Regarding available treatments, the use of effective doses during an adequate period followed by augmentation with a second and/or third agent, and finally switching to other agent are steps frequently necessary to optimize efficacy. However, in the treatment-resistant paradigm, drugs mimicking standard strategies, which target preferentially the monoaminergic system, can present reduced therapeutic effects. Thus, the search for new effective treatments for mood disorders is critical to decreasing the overall morbidity secondary to treatment resistance.


CONCLUSIONS
Emerging strategies targeting brain plasticity pathways or 'plasticity enhancers', including antiglutamatergic drugs, glucocorticoid receptor antagonists and neuropeptides, have been considered promising therapeutic options for difficult-to-treat mood disorders.
Machado-Vieira
Rodrigo
R
Programa de Transtornos do Humor e Ansiedade, National Institute of Mental Health, National Institutes of Health, Bethesda, MD 20892-3711, USA. machadovieirar@terra.com.br
Soares
Jair C
JC
D000928:Antidepressive Agents / Q000627:therapeutic use*; D014150:Antipsychotic Agents / Q000627:therapeutic use*; D001714:Bipolar Disorder / Q000188:drug therapy; D003865:Major Depressive Disorder / Q000188:drug therapy; D004351:Drug Resistance; D004359:Drug Therapy, Combination; D006801:Humans; D019964:Mood Disorders / Q000188:drug therapy* / Q000503:physiopathology / Q000523:psychology; D009473:Neuronal Plasticity; D012033:Refractory Period, Psychological; D013315:Stress, Psychological / Q000150:complications
D000928:Antidepressive Agents; D014150:Antipsychotic Agents