Treatment-Resistant Depression represents a significant population of patients with major depressive disorders
Major Depressive Disorder (MDD) is a recurring and chronic illness. Patients frequently return for two or more episodes of depression, and these episodes often last two years or more.
After a single major depressive episode, the risk of a second episode is about 50%; after a third episode, the risk of a fourth is about 90%. Each new episode tends to occur sooner and more abruptly, and new episodes can occur, often presenting the same or more severe symptoms1.
Treatment Responsiveness of Patients with Treatment-Resistant Depression (TRD)
Some depressed patients do not adequately respond to the more commonly prescribed antidepressants, and continue to suffer from symptoms of depression. These patients may have Treatment-Resistant Depression (TRD). Among the TRD patients, approximately 22%-30% may achieve remission. A common definition used for TRD is:
- Failure to respond to 3 or more courses of antidepressant therapy2
Treatment of depressed patients that do not respond to multiple antidepressant treatments has rarely been studied systematically. ECT has long been considered the primary option for patients with treatment-resistant depression, but high rates of relapse, cognitive side effects, and poor acceptability make this option problematic. Monoamine oxidase inhibitors (MAOIs), such as Marplan, are an alternative to ECT for treatment-resistant depression.
- Marplan is unique among the irreversible MAOIs in that it was studied in the largest number of placebo-controlled trials supporting the safety and efficacy of its use in the treatment of depression3.
References:
- Keller MB. Issues in treatment-resistant depression. J Clin Psychiatry. 2005;66 Suppl 8:5-12. Review.
- Rush AJ, Trivedi M, Fava M. Depression, IV: STAR*D treatment trial for depression. Am J Psychiatry. 2003 Feb;160(2):237. No abstract available.
- Davidson, J., Lipper, S., Pelton, S., Miller, R. D., Hammett, E. B., Mahorney, S., et al. (1988). The response of depressed inpatients to isocarboxazid. J Clin Psychopharmacol, 8(2), 100-107.
Please see Full Prescribing Information including BOXED WARNINGS regarding increased risk of suicidality in children and adolescents. MAO-Inhibitors are contraindicated with certain drugs. Potential hypertensive crises may occur with foods that contain tyramine. As with all antidepressants, patients should be observed closely for clinical worsening, suicidality, and unusual changes in behavior, especially during the initial few months of treatment.
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