Treatment-resistant depression: Newer alternatives
What is your next move after treatment helps a depressed patient but remission is incomplete? Augment the SSRI or combine it with something else? Switch SSRIs? Try somatic therapy? The authors analyze options in light of the evidence—or lack thereof.
Vagus Nerve Stimulation The NeuroCybernetic Prosthesis System (Cyberonics, Inc., Houston, Tex) stimulates the left cervical vagus nerve for treatment of resistant partial-onset epileptic seizures.
An open treatment trial of vagus nerve stimulation (VNS) for treatment-resistant depression was done based on mood improvement observed in patients treated for seizure disorders. Positron-emission tomographic studies revealed activation of limbic structures and neurochemical and neuronal pathway findings.23 The investigators reported improvement in a sample of 30 patients with major depressive disorder. Definite conclusions await controlled clinical trials and more work is needed to determine the ultimate mechanisms that might be antidepressant.23,24
Related resources
- Amsterdam JD, Hornig M, Nierenberg AA. Treatment-resistant mood disorders. Cambridge, UK: Cambridge University Press; 2001.
- Stahl SM. Essential Psychopharmacology. Cambridge, UK: Cambridge University Press; 1996.
- STAR*D Web site: https://www.edc.gsph.pitt.edu/stard
Drug brand names
- Bupropion • Wellbutrin, Wellbutrin SR, Zybar
- Buspirone • BuSpar, BuSpar DIVIDOSE
- Citalopram • Celexa
- Fluoxetine • Prozac, Prozac Weekly
- Gabapentin • Neurontin
- Haloperidol • Haldol, Haldol Decanoate
- Lamotrigine • Lamictal
- Mirtazapine • Remeron, Remeron Soltab
- Modafinil • Provigil
- Nefazodone • Serzone
- Olanzapine • Zyprexa
- Paroxetine • Paxil
- Pergolide • Permax
- Pramipexole • Mirapex
- Reboxetine • Edronax
- Risperidone • Risperidal
- S-adenosyl-methionine • SAM-e
- Sertaline • Zoloft
- Tranycypromine • Nardil, Parnate, Marplan
- Valproate • Epival, Deprox, Alti-Valproic
- Venlafaxine • Effexor, Effexor X12
- Ziprasadone • Geodon
Disclosure
Dr. Alpert receives research funding, speaking honoraria or consultation fees from Organon, Forest Pharmaceuticals, GlaxoSmithKline, Pfizer Inc., and Pharmavite.
Dr. Nierenberg receives research funding, speaking honoraria, or consultation fees from Eli Lilly and Co., Wyeth-Ayerst Pharmaceuticals, GlaxoSmithKline, Janssen Pharmaceutica, Innapharma, BMS, Cyberonics, Lichtner, and Pfizer Inc.
