Prakt. lékáren. 2021; 17(3): 153-156 [Psychiatr. praxi. 2020;21(3):124-127]

Treatment options for pharmacoresistant depression in routine clinical practice

Eva Češková^{1, 2}, Petr Šilhán^{2, 3}

¹ Psychiatrická klinika LF MU a FN Brno

² KNP LF Ostravské univerzity

³ Oddělení psychiatrické FN Ostrava

Most psychiatrists consider depression to be pharmacoresistant in the setting of an inadequate response to two adequate antidepressant courses. For research purposes and for the testing of various pharmacotherapeutic strategies, several models involving more degrees of pharmacoresistance have been proposed. The present article deals with the treatment options for pharmacoresistant depression in routine clinical practice. They include antidepressant switching, augmentation, and combinations. In patients with severe depression and suicidality, fast-acting antidepressants are an option. The most widespread method of augmentation is that with second-generation antipsychotics. In a proportion of patients with inflammatory markers, anti-inflammatory agents appear to be suitable. Even in pharmacoresistant depression, healthy lifestyle, particularly physical activity and healthy diet, is a neglected and available augmentation option. A combination of antidepressants typically aimed at persisting and predominant symptoms is also common.

Keywords: pharmacoresistant depression, antidepressant switch, multimodal antidepressant, fast-acting antidepressant, augmentation, anti-inflammatory agents, healthy lifestyle, antidepressant combination.

Published: October 12, 2021  Show citation