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Practical Management
Management of patients with treatment-resistant bipolar disorder is complicated by the need to be vigilant about the possibility of affective switch, as well as the current symptomatology targeted…

Other Treatment Options

Sleep Deprivation
Sleep deprivation to treat depression was first proposed by Schulte in 1969. Total sleep deprivation is defined as lack of sleep for an entire…

Treatment-Resistant Bipolar Disorder

Switching Strategies
When patients do not respond to treatment with one antidepressant, a common clinical strategy is to switch antidepressants. Although a change to an antidepressant of the same class…

Combined SSRIs and TCAs  The strategy of combining fluoxetine or other SSRIs with a TCA in the treatment of patients with refractory depression has been popular. An early…

SSRI-nefazodone combination  To date, only anecdotal reports have suggested the efficacy of combining SSRIs with nefazodone—typically at 100 or 200 mg bid. There is one report of this combination resulting…

Combined MAOIs and TCAs  Although in the 1960s combined antidepressant therapy with MAOIs and TCAs was more common, involving up to 5% of all antidepressant prescriptions (Tyrer and…

Combined Antidepressant Treatments
How should antidepressants be combined and for how long?  The term combination strategy in resistant depression typically refers to the addition to an antidepressant of…

Higher-Dose Antidepressants
What clinical trial evidence for the use of higher-dose antidepressants in treatment-refractory depression is available?  An alternative approach to switching is the use of relatively high doses…

Buspirone augmentation  One relatively user-friendly strategy is buspirone augmentation. Buspirone is typically a well-tolerated anti-anxiety drug, an azaspirodecanedione and a partial serotonin type 1 (5-HT₁) agonist. Three patients whose depression…

Dopaminergic and stimulant augmentation  Dopamine has received less attention than either serotonin or noradrenaline as a factor in the pathogenesis and treatment of depression, although preclinical and clinical…

Thyroid augmentation  The addition of thyroid hormone to an antidepressant in antidepressant nonresponders has been reported since the late 1960s. In one case series of women, thyroid hormone, when prescribed…

Treatment-Resistant Unipolar Depression: Antidepressant Treatment Options
If a depressed patient does not respond to an antidepressant after an optimized medication trial, the physician can choose one of four treatment strategies: augment the failed…

Treatment-Resistant Unipolar Depression: Depressive Subtypes and Treatment Response
Since the introduction of TCAs in the 1950s, clinicians and clinical researchers have attempted to define depressive subtypes to predict response to these…

Treatment of Mood Disorders: Summary
As knowledge expands about the influence of psychiatric illness on the medically ill, more is learned about specific treatment of mood disorders, which affects prognosis, morbidity,…

Treatment of Mood Disorders: Neoplasm
The rates of depression among patients with cancer range from 1.5% to 50%, depending on the location of the primary tumor. The highest prevalence of…

Treatment of Mood Disorders: Pulmonary Diseases
The occurrence of depression in patients with chronic obstructive pulmonary disease (COPD) has been found to be approximately 45%. The selection of an…

Treatment of Mood Disorders: Diabetes Mellitus
The high prevalence of psychiatric illness in the diabetic population has been significantly evaluated only in recent years. In a study of 114…

Treatment of Mood Disorders: Neurological Illnesses
Cerebrovascular accident and Parkinson’s disease are two neurological illnesses associated with a high incidence of comorbid depression after initial neurological insult. Within a…

Treatment of Mood Disorders: Renal Disease
It is unclear whether psychiatric illness or specific mood disorders are related to renal disease or to the psychological distress associated with dialysis…

Treatment of Mood Disorders: Rheumatoid Arthritis
Depressive symptoms occur in 17%-27% of patients with rheumatoid arthritis. One study compared the prevalence of a psychiatric diagnosis in patients with musculoskeletal…

Treatment of Mood Disorders: Specific Medical Illnesses

Cardiovascular Disease
Exciting progress has been made involving the relationship of coronary artery disease (CAD) and depression. Among patients with CAD,…

Treatment of Mood Disorders: Psychotherapy
Although the Agency for Health Care Policy and Research has published a set of practice guidelines on depression in the primary care/medically ill sector that…

Treatment of Mood Disorders: Electroconvulsive Therapy
Electroconvulsive therapy (ECT) is an often-used modality in the treatment of mood disorders with comorbid medical problems. ECT generally has been reserved for…