title: Treatment resistant depression: strategies for primary care.
abstract: Depression is commonly diagnosed and treated in primary care. Recent evidence indicates that the majority of depressed patients will not fully recover with an initial antidepressant treatment. This paper reviews commonly used options for treatment after an inadequate initial antidepressant response. The alternatives range widely, and include escalating the dose of the initial antidepressant, switching to an alternative medication, combining two antidepressants with different mechanisms of action (e.g., bupropion + SSRI or mirtazapine + venlafaxine), adding other medications such as lithium or certain atypical antipsychotics (olanzapine, aripiprazole, or quetiapine) to the antidepressant, adding a natural product such as l-methylfolate or s-adenosylmethionine (SAMe), or adding cognitive behavioral psychotherapy. What agent to be used will depend on the comfort level of the primary care practitioner and the availability of Psychiatry referral. However, it is reasonable to take one or more additional steps to attempt to achieve remission.
authors.affiliation: Department of Psychiatry and Behavioral Neurobiology, The University of Alabama at Birmingham, SC 1026 1720 2nd Ave S, Birmingham, AL 35294-0018, USA.
authors.forename: Taylor C
authors.initials: TC
authors.lastname: Preston
authors.forename: Richard C
authors.initials: RC
authors.lastname: Shelton
mesh_terms: D000928:Antidepressive Agents / Q000627:therapeutic use*; D014150:Antipsychotic Agents / Q000627:therapeutic use*; D061218:Depressive Disorder, Treatment-Resistant / Q000188:drug therapy*; D057915:Drug Substitution; D004359:Drug Therapy, Combination / Q000379:methods; D006801:Humans
chemical_list: D000928:Antidepressive Agents; D014150:Antipsychotic Agents