Absolute treatment resistance
In most surveys, the number of patients with absolute treatment resistance is very small. In some specialized tertiary referral clinics, only about 7% of patients remain depressed after 1 year of extensive investigations and treatment. However, extensive treatment involves many drug trials, singly and in combination, as well as ECT. Typically, people with absolute treatment resistance are older (mean age about 55), have been depressed for a longer period of time, and have insoluble life problems. Some help can be offered, even to this group of patients. Carefully prescribed, psychostimulants can help to decrease depression and increase energy. In this context, psychostimulants can be seen as psychic painkillers and their use can be compared with that of analgesics in other chronic pain syndromes.
Supportive and cognitive psychotherapy can also be of benefit. Supportive psychotherapy allows depressed patients to carry on in the face of a handicap; cognitive psychotherapy allows some patients to view the world differently, and this can lead to positive thinking and beneficial lifestyle changes, such as regular exercise, cessation of smoking, and reduction of alcohol consumption. Jogging has been reported to have an antidepressant effect.
Conclusion
Treatment-resistant depression is a relative term. All patients can at some point be considered relatively resistant to therapy, depending on how far the physician is willing to go in the patient’s treatment. The appropriate use of tricyclic or heterocyclic antidepressants or MAOIs can relieve the symptoms of at least two thirds of patients. Drug combinations, ECT, or augmentation strategies can, if vigorously applied, reduce the percentage of patients who are truly treatment resistant to about 7%. Considering the morbidity and mortality associated with depression, a vigorous approach to therapy is worthwhile.
Résumé
(French Language)
De nombreux facteurs peuvent influencer le résultat du traitement de la dépression, un problème de santé communautaire important et qui comporte un taux significatif de mortalité et de morbidité. Les deux tiers des patients répondront bien aux antidépresseurs. Les autres seront traités par d’autres moyens. Seuls 7% des patients seront absolument résistants au traitement, mais il est tout de même possible de leur venir en aide.