November 2012

Terapiresistente depressioner: Den skjulte tredjedel

Artiklen giver en god oversigt over problemet med de terapiresistente depressioner, den skjulte tredjedel. Litteraturen gennemgås og forskellige behandlingsstrategier omtales. Forfatterne argumenterer for at et enkelt kriterie som remission ikke er tilstrækkelig, og at det er nødvendigt at se på funktionsniveauet. Det er et tema som er kommet i fokus i de senere år med forsøg på at udvikle test til vurdering af kognitiv funktion og metoder til kognitiv remediering.

Abstract
Treatment-resistant depression (TRD) presents many challenges for both patients and physicians. This review aims to evaluate the current status of the field of TRD and reflects the main findings of a consensus meeting held in September 2009. Literature searches were also conducted using Pubmed and EMBASE. Abstracts of the retrieved articles were reviewed independently by the authors for inclusion. Evaluation of the clinical evidence in TRD is complicated by the absence of a validated definition, and there is a need to move away from traditional definitions of remission based on severity of symptoms to one that includes normalisation of functioning. One potential way of improving treatment of TRD is through the use of predictive biomarkers and clinical variables. The advent of new treatments may also help by focusing on neurotransmitters other than serotonin.  Strategies such as the switching of antidepressants, use of combination therapy with lithium, atypical antipsychotics and other pharmacological agents can improve outcomes, and techniques such as deep brain stimulation and vagus nerve stimulation have shown promising early results. Despite consistent advances in the pharmacotherapy of mood disorders in the last decade high rates of TRD are still a challenging aspect of overall management.

The hidden third: Improving outcome in treatment-resistant depression.
Thomas E Schlaepfer, Hans Ågren, Palmiero Monteleone, Cristobal Gasto, William Pitchot, Frederick Rouillon, David J Nutt and Siegfried Kasper.
Journal of Psychopharmacology 2012; 26(5):587-602.

Erik Roj Larsen, overlæge. Medlem af DPS’ forskningsudvalg.