Posted by OldSchool on March 22, 2002, at 21:29:31
In reply to Re: Article on treatment resistant depression, posted by Elizabeth on March 22, 2002, at 21:00:33
> I hope that advances in neurobiology may offer new clues about different types of "major depression."
I read something Dr. Mark George wrote where he said he wouldnt be suprised that in ten or fifteen more years its been discovered that there are actually ten different types of depression. Mostly due to functional neuroimaging research. Like that Dr. Amen guy says there are more than one type of ADD, Ive read all the different subtypes of ADD that guy has created based on his functional neuroimaging work.
This work would go faster I bet if psychiatry was just formally merged into Neurology. This is BRAIN stuff, not psychology or "mind" stuff.
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> * Comorbidity can also affect response to different treatments. Again, not a lot is known about this, but there is some evidence that anxiety disorders, personality disorders, and bipolarity can contribute to treatment resistance. This may be one of the reasons why pdocs are so gung-ho about diagnosing bipolar disorder these days. :-} A problem is that there isn't much research on the treatment of depression associated with these other conditions; the diagnosis of bipolar disorder has also gotten fuzzy of late.I think there are a whole bunch of things which can cause antidepressants not to work well. Subtle bipolar problems is just one of them.
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> I was surprised to read that nomifensine (Merital) didn't seem especially effective for TCA-resistant depression; it seems like there are a lot of people out there who were very impressed by it and who've had a history of many medication failures. I would at least have expected it to have a better response rate than trazodone, of all things. (Does anybody even use trazodone as an AD anymore?)I wouldnt believe what you read about nomifensine being an ineffective antidepressant. It was one of the best ADs ever fielded from things Ive read. Certainly as good as a TCA and without the anti-cholinergic side effects.
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> FWIW, I recall reading somewhere-or-other that about 80% of depressed patients will respond to one of the first three ADs tried (assuming that adequate doses and trial durations are used and that the ADs are selected rationally, based on what limited information is available). That's pretty good, and maybe the variety of ADs now available improves it further. But it still leaves a lot of room for improvement.Yeah but remember that "response" is not a full remission, which is the objective of depression treatment. I read that all antidepressants must do to be FDA approved is achieve a response rate of a 50% improvement on the Hamilton questionaire. The full remission rate of most antidepressants is not that great for severe depression. The treatment that has the highest rate of full remission is bilateral ECT. MAOIs also are good at creating full remission. But nobody wants to do the last two options cause of the side effect profile.
There are a lot of things left to be desired in the treatment of severe depression.
Old School
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poster:OldSchool
thread:98605
URL: http://www.dr-bob.org/babble/20020322/msgs/99556.html