title: What to expect from a third step in treatment resistant depression: A prospective open study on escitalopram.
abstract: OBJECTIVE
  Only few studies investigated treatment strategies for treatment resistant depression (TRD). The objective of this multicentre study was to evaluate TRD patients who did not respond to at least two antidepressants.
  
  
  METHODS
  A total of 417 patients, who failed to respond to a previous retrospectively assessed antidepressant (AD1), were firstly included in a 6-week venlafaxine treatment (AD2); secondly, those who failed to respond were treated for further 6 weeks with escitalopram (AD3).
  
  
  RESULTS
  Out of 417 patients who had failed to respond to previous treatment (AD1), 334 completed treatment with venlafaxine to prospectively define TRD. In the intent to treat (ITT) population in the first phase of the trial (AD2), responders to venlafaxine were 151 (36.21%) out of which remitters were 83 (19.90%). After phase one, 170 non-responders, defined as TRD, were included in the second phase and 157 completed the course. Of the 170 ITT entering the second phase (AD3), responders to escitalopram were 71 (41.76%) out of which remitters were 39 (22.94%). After the third treatment, patients showed a dropout rate of 7.65% and a rate of presence of at least one serious adverse event of 19.18%.
  
  
  CONCLUSIONS
  Relevant rates of response and remission may be observed after a third line treatment in patients resistant to two previous treatments. A relevant limitation of this study was represented by the design: naturalistic, non-randomized, open-label, without a control sample and with unblinded raters.
authors.affiliation: a Laboratoire de Psychologie Médicale, Université Libre de Bruxelles, and Centre Européen de Psychologie Médicale-PsyPluriel , Brussels , Belgium.
authors.forename: Daniel
authors.initials: D
authors.lastname: Souery
authors.affiliation: b IRCCS Centro S. Giovanni di Dio, Fatebenefratelli , Brescia , Italy.
authors.forename: Raffaella
authors.initials: R
authors.lastname: Calati
authors.affiliation: c Department of Psychiatry and Psychotherapy , Medical University Vienna , Vienna , Austria.
authors.forename: Konstantinos
authors.initials: K
authors.lastname: Papageorgiou
authors.affiliation: d Chaim Sheba Medical Center , Tel-Hashomer , Israel.
authors.forename: Alzbeta
authors.initials: A
authors.lastname: Juven-Wetzler
authors.affiliation: e Cabinet Médical Ambroise Paré , Elancourt , France.
authors.forename: Joël
authors.initials: J
authors.lastname: Gailledreau
authors.affiliation: f Toulouse , France.
authors.forename: David
authors.initials: D
authors.lastname: Modavi
authors.affiliation: g Département de Psychiatrie Hôpitaux Universitaires de Genève, Faculté de Médecine de Genève , Geneva , Switzerland.
authors.forename: Othman
authors.initials: O
authors.lastname: Sentissi
authors.affiliation: h Service de Psychiatrie et de Psychologie Médicale, CHU Liège , Liège , Belgium.
authors.forename: William
authors.initials: W
authors.lastname: Pitchot
authors.affiliation: i First Department of Psychiatry , Athens University Medical School, Eginition Hospital , Athens , Greece.
authors.forename: George N
authors.initials: GN
authors.lastname: Papadimitriou
authors.affiliation: i First Department of Psychiatry , Athens University Medical School, Eginition Hospital , Athens , Greece.
authors.forename: Dimitris
authors.initials: D
authors.lastname: Dikeos
authors.affiliation: j Imperial College, University of London , London , UK.
authors.forename: Stuart
authors.initials: S
authors.lastname: Montgomery
authors.affiliation: c Department of Psychiatry and Psychotherapy , Medical University Vienna , Vienna , Austria.
authors.forename: Siegfried
authors.initials: S
authors.lastname: Kasper
authors.affiliation: d Chaim Sheba Medical Center , Tel-Hashomer , Israel.
authors.forename: Joseph
authors.initials: J
authors.lastname: Zohar
authors.affiliation: k Department of Biomedical and NeuroMotor Sciences , University of Bologna , Bologna , Italy.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Serretti
authors.affiliation: l Université Libre de Bruxelles , Brussels , Belgium.
authors.forename: Julien
authors.initials: J
authors.lastname: Mendlewicz
mesh_terms: D000328:Adult; D000928:Antidepressive Agents / Q000627:therapeutic use*; D015283:Citalopram / Q000627:therapeutic use*; D003865:Major Depressive Disorder / Q000188:drug therapy*; D061218:Depressive Disorder, Treatment-Resistant / Q000188:drug therapy*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011569:Psychiatric Status Rating Scales; D000068760:Serotonin and Noradrenaline Reuptake Inhibitors / Q000627:therapeutic use; D016896:Treatment Outcome; D000069470:Venlafaxine Hydrochloride / Q000627:therapeutic use
chemical_list: D000928:Antidepressive Agents; D000068760:Serotonin and Noradrenaline Reuptake Inhibitors; D015283:Citalopram; D000069470:Venlafaxine Hydrochloride
keywords: antidepressants; escitalopram; major depressive disorder; pharmacotherapy; resistant depression