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S061-2

The Efficacy of Combination Therapy or Switching Antidepressants and Mood
Stabilizers for Treatment Resistant Depression

Hikaru Hori

Department of Psychiatry, University of Occupational and Environmental Health, Japan

Background/Objective: Treatment resistant depression (TRD) is commonly regarded as a failure of
depression to respond to two adequate course of antidepressants. Results from the STAR*D study
indicate that <30% of patients with major depressive disorder remitted to the selective serotonin
reuptake inhibitor (SSRI), citalopram. Remitter rates for the first two steps of STAR*D suggest that
close to half of patients with MDD suffered from TRD. As recently noted, TRD probably accounts
for approximately 20~30% of MDD patients.

A variety of approaches have been delineated in the management of TRD. The first step is generally
optimization of the current regimen, which may include dosing changes, extension of treatment for
longer periods of time, and use of drug plasma levels, if appropriate. Next steps often include
switching and augmentation therapy. Mood stabilizers such as lithium and lamotrigine, atypical
antipsychotics such as aripiprazole, risperidone, quetiapine and olanzapine, antidepressants such as
selective serotonin reuptake inhibitors, serotonin norepinephrine reuptake inhibitors, and mirtazapine,
serotonin autoreceptor antagonists such as pindolol, dopamine agonists, and thyroid hormone are
well known as drugs used in both switching and augmentation therapy. The efficacies of modified
electroconvulsive therapy and repetitive transcranial magnetic stimulation have also been examined.

In this symposium, I will outline the efficacies and safety profiles of drugs, such as antidepressants
and mood stabilizers, used for TRD.