Is there a place for tricyclic antidepressants and subsequent augmentation strategies in obtaining remission for patients with treatment resistant depression?
Major depressive disorder is a worrying mental health problem and obtaining remission from treatment resistant depression (TRD) remains an important clinical issue. Twenty patients (14 women, 6 men) considered as treatment resistant after the fourth step of a seven-step treatment algorithm to obtain remission in major depression received clomipramine 150 mg/day for 1 month (step 5). In case of failure, two subsequent augmentation strategies with lithium and lithium plus triiodothyronine (T3) were implemented. Median Montgomery-Asberg Depression Rating Scale (MADRS) score at initiation of clomipramine treatment was 29 (range 8-43). Treatment with clomipramine alone allowed five patients to achieve sustained remission (MADRS < or = 8), while three patients were responders (MADRS decrease > or = 50%) and three patients were partial responders (MADRS decrease > 25%). Lithium augmentation in 10 patients led to one additional remission, whereas no additional remission was observed in 6 patients with further T3 augmentation. Tricyclic antidepressants have demonstrated efficacy in TRD. The present study suggests that treatment with clomipramine might allow obtaining remission in some patients who do not fully respond despite multiple interventions.
Gervasoni
Nicola
N
Clinique La Metairie, Nyon, Switzerland. ngervasoni@lametairie.ch
Aubry
Jean-Michel
JM
Gex-Fabry
Marianne
M
Bertschy
Gilles
G
Bondolfi
Guido
G
D000328:Adult; D000929:Antidepressive Agents, Tricyclic / Q000627:therapeutic use*; D002997:Clomipramine / Q000627:therapeutic use*; D003865:Major Depressive Disorder / Q000188:drug therapy*; D004351:Drug Resistance; D005260:Female; D006801:Humans; D018020:Lithium Compounds / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D011569:Psychiatric Status Rating Scales; D014284:Triiodothyronine / Q000627:therapeutic use*
D000929:Antidepressive Agents, Tricyclic; D018020:Lithium Compounds; D014284:Triiodothyronine; D002997:Clomipramine