Diagnóstico e estratégia terapêutica na depressão resistente ao tratamento
Palavras-chave:
depressão resistente, depressão refratária, transtorno depressivo maior, DRTResumo
Depressão resistente ao tratamento (DRT) é uma condição clínica de alta prevalência e grande impacto na qualidade de vida dos pacientes. Apesar de muito prevalente, diversos pacientes são erroneamente diagnosticados como resistentes. O tratamento inadequado do quadro depressivo, a baixa adesão medicamentosa, o diagnóstico incorreto de depressão e a presença de comorbidades são alguns dos fatores que contribuem para uma baixa resposta clínica aos antidepressivos. Existe atualmente um amplo arsenal terapêutico para o tratamento da DRT. Estratégias como otimização, troca, combinação e/ou potencialização dos antidepressivos são a base do tratamento farmacológico na depressão resistente. Terapêuticas neuromodulatórias, como a eletroconvulsoterapia e a estimulação magnética transcraniana, e a psicoterapia adjuvante são ferramentas também importantes no manejo desses pacientes. Portanto, a identificação correta da DRT e o conhecimento do seu tratamento baseado em evidências permitirão que os profissionais de saúde possam tratar de forma adequada este grupo de pacientes.
Referências
Bromet E, Andrade LH, Hwang I, et al. Cross-national epidemiology of DSM-IV major depressive episode. BMC Med. 2011;9:90. doi:10.1186/1741-7015-9-90
WHO. Depression, a global public health concern. WHO Dep Ment Heal Subst Abus. 2012:1-8. doi:10.1007/978-3-642-11688-9_20
Rizvi SJ, Grima E, Tan M, et al. Treatment-resistant depression in primary care across Canada. Can J Psychiatry. 2014;59(7):349-357. doi:10.1177/070674371405900702
Gałecki P, Samochowiec J, Mikułowska M, Szulc A. Treatment-Resistant Depression in Poland-Epidemiology and Treatment. J Clin Med. 2022;11(3):1-16. doi:10.3390/jcm11030480
Soares B, Kanevsky G, Teng CT, et al. Prevalence and Impact of Treatment-Resistant Depression in Latin America: a Prospective, Observational Study. Psychiatr Q. 2021;92(4):1797-1815. doi:10.1007/s11126-021-09930-x
Rybak YE, Lai KSP, Ramasubbu R, et al. Treatment-resistant major depressive disorder: Canadian expert consensus on definition and assessment. Depress Anxiety. 2021;38(4):456-467. doi:10.1002/da.23135
Berlim MT, Turecki G. Treatment-Resistant Refractory Major Depression: A Review of Current Concepts and Methods. Methods. 2007;52(1):46-54. doi:10.1177/070674370705200108
Ruhé HG, Van Rooijen G, Spijker J, Peeters FPML, Schene AH. Staging methods for treatment resistant depression. A systematic review. J Affect Disord. 2012;137(1-3):35-45. doi:10.1016/j.jad.2011.02.020
Kornstein SG, Schneider RK. Clinical Features of Treatment-Resistant Depression. Psychiatry Interpers Biol Process. 2001.
Dr. Dana L. McMakin, PhD, Dr. Thomas M. Olino, PhD, Ms. Giovanna Porta, MS, Dr. Laura J. Dietz, PhD, Dr. Graham Emslie, MD, Dr. Gregory Clarke, PhD, Dr. Karen Dineen Wagner, MD, PhD, Dr. Joan R. Asarnow, PhD, Dr. Neal D. Ryan, MD, Dr. Boris Birmaher, MD, M. Anhedonia Predicts Poorer Recovery among Youth with Selective Serotonin Reuptake Inhibitor-Treatment Resistant Depression. J Am Acad Child Adolesc Psychiatry. 2012;51(4):404-411. doi: 10.1016/j.jaac.2012.01.011
Correa R, Akiskal H, Gilmer W, Nierenberg AA, Trivedi M, Zisook S. Is unrecognized bipolar disorder a frequent contributor to apparent treatment resistant depression? J Affect Disord. 2010;127(1-3):10-18. doi:10.1016/j.jad.2010.06.036
Souery D, Oswald P, Massat I, et al. Clinical factors associated with treatment resistance in major depressive disorder: results from a European multicenter study. J Clin Psychiatry. 2007;68(7):1062-1070. doi:10.4088/JCP.v68n0713
Cipriani A, Furukawa TA, Salanti G, et al. Comparative efficacy and acceptability of 21 antidepressant drugs for the acute treatment of adults with major depressive disorder: a systematic review and network meta-analysis. Lancet. 2018;391(10128):1357-1366. doi:10.1016/S0140-6736(17)32802-7
Tundo A, Filippis R de, Proietti L. Pharmacologic approaches to treatment resistant depression: Evidences and personal experience. World J Psychiatry. 2015;5(3):330. doi:10.5498/wjp.v5.i3.330
Souery D, Serretti A, Calati R, et al. Switching antidepressant class does not improve response or remission in treatment-resistant depression. J Clin Psychopharmacol. 2011;31(4):512-516. doi:10.1097/JCP.0b013e3182228619
Bschor T, Baethge C. No evidence for switching the antidepressant: Systematic review and meta-analysis of RCTs of a common therapeutic strategy: Review. Acta Psychiatr Scand. 2010;121(3):174-179. doi:10.1111/j.1600-0447.2009.01458.x
Kennedy SH, Lam RW, McIntyre RS, et al. Canadian Network for Mood and Anxiety Treatments (CANMAT) 2016 clinical guidelines for the management of adults with major depressive disorder: Section 3. Pharmacological Treatments. Can J Psychiatry. 2016;61(9):540-560. doi:10.1177/0706743716659417
Rush AJ, Trivedi MH, Stewart JW, et al. Combining Medications to Enhance Depression Outcomes (CO-MED): Acute and long-term outcomes of a single-blind randomized study. Am J Psychiatry. 2011;168(7):689-701. doi:10.1176/appi.ajp.2011.10111645
Si T, Wang P. When is antidepressant polypharmacy appropriate in the treatment of depression? Shanghai Arch Psychiatry. 2014;26(6):357-359. doi:10.11919/j.issn.1002-0829.214152
Nelson JC, Papakostas GI, J. Craig Nelson MD, George I. Papakostas MD. Atypical Antipsychotic Augmentation in Major Depressive Disorder: A Meta-Analysis of Placebo-Controlled Randomized Trials. Am J Psychiatry. 2009;166(September):980-991. doi:10.1176/appi.ajp.2009.09030312
Nelson JC, Baumann P, Delucchi K, Joffe R, Katona C. A systematic review and meta-analysis of lithium augmentation of tricyclic and second generation antidepressants in major depression. J Affect Disord. 2014;168:269-275. doi:10.1016/j.jad.2014.05.053
Aronson R, Offman HJ, Joffe RT, Naylor CD. Triiodothyronine augmentation in the treatment of refractory depression. A meta-analysis. Arch Gen Psychiatry. 1996;53(9):842-848. doi:10.1001/archpsyc.1996.01830090090013
Ricken R, Ulrich S, Schlattmann P, Adli M. Tranylcypromine in mind (Part II): Review of clinical pharmacology and meta-analysis of controlled studies in depression. Eur Neuropsychopharmacol. 2017;27(8):714-731. doi:10.1016/j.euroneuro.2017.04.003
Thomas SJ, Shin M, McInnis MG, Bostwick JR. Combination therapy with monoamine oxidase inhibitors and other antidepressants or stimulants: Strategies for the management of treatment-resistant depression. Pharmacotherapy. 2015;35(4):433-449. doi:10.1002/phar.1576
ANVISA. Agência Nacional de Vigilância Sanitária. https://consultas.anvisa.gov.br/#/pareceres/q/?nomeProduto=SPRAVATO. Accessed April 14, 2022.
Fedgchin M, Trivedi M, Daly EJ, et al. Efficacy and Safety of Fixed-Dose Esketamine Nasal Spray Combined with a New Oral Antidepressant in Treatment-Resistant Depression: Results of a Randomized, Double-Blind, Active-Controlled Study (TRANSFORM-1). Int J Neuropsychopharmacol. 2019;22(10):616-630. doi:10.1093/ijnp/pyz039
Popova V, Daly EJ, Trivedi M, et al. Efficacy and safety of flexibly dosed esketamine nasal spray combined with a newly initiated oral antidepressant in treatment-resistant depression: A randomized double-blind active-controlled study. Am J Psychiatry. 2019;176(6):428-438. doi:10.1176/appi.ajp.2019.19020172
Daly EJ, Singh JB, Fedgchin M, et al. Efficacy and safety of intranasal esketamine adjunctive to oral antidepressant therapy in treatment-resistant depression: A randomized clinical trial. JAMA Psychiatry. 2018;75(2):139-148. doi:10.1001/jamapsychiatry.2017.3739
Milev R V., Giacobbe P, Kennedy SH, et al. Canadian Network for Mood and Anxiety Treatments (CANMAT) 2016 clinical guidelines for the management of adults with major depressive disorder: Section 4. Neurostimulation treatments. Can J Psychiatry. 2016;61(9):561-575. doi:10.1177/0706743716660033
Parikh S V., Quilty LC, Ravitz P, et al. Canadian Network for Mood and Anxiety Treatments (CANMAT) 2016 clinical guidelines for the management of adults with major depressive disorder: Section 2. Psychological treatments. Can J Psychiatry. 2016;61(9):524-539. doi:10.1177/0706743716659418
Zakhour S, Nardi AE, Levitan M, Appolinario JC. Cognitive-behavioral therapy for treatment-resistant depression in adults and adolescents: A systematic review. Trends Psychiatry Psychother. 2020;42(1):92-101. doi:10.1590/2237-6089-2019-0033
Lynch TR, Hempel RJ, Whalley B, et al. Refractory depression - Mechanisms and efficacy of radically open dialectical behaviour therapy (RefraMED): Findings of a randomised trial on benefits and harms. Br J Psychiatry. 2020;216(4):204-212. doi:10.1192/bjp.2019.53
Hollon SD, DeRubeis RJ, Shelton RC, et al. Prevention of relapse following cognitive therapy vs medications in moderate to severe depression. Arch Gen Psychiatry. 2005;62(4):417-422. doi:10.1001/archpsyc.62.4.417
Scott J, Teasdale JD, Paykel ES, et al. Effects of cognitive therapy on psychological symptoms and social functioning in residual symptoms and social functioning in residual depression. Br J Psychiatry. 2000;177:440-446.
Cladder-Micus MB, Speckens AEM, Vrijsen JN, T. Donders AR, Becker ES, Spijker J. Mindfulness-based cognitive therapy for patients with chronic, treatment-resistant depression: A pragmatic randomized controlled trial. Depress Anxiety. 2018;35(10):914-924. doi:10.1002/da.22788
Kuyken W, Warren FC, Taylor RS, et al. Efficacy of mindfulness-based cognitive therapy in prevention of depressive relapse an individual patient data meta-analysis from randomized trials. JAMA Psychiatry. 2016;73(6):565-574. doi:10.1001/jamapsychiatry.2016.0076
Strauss C, Cavanagh K, Oliver A, Pettman D. Mindfulness-based interventions for people diagnosed with a current episode of an anxiety or depressive disorder: A meta-analysis of randomised controlled trials. PLoS One. 2014;9(4). doi:10.1371/journal.pone.0096110
Van Bronswijk S, Moopen N, Beijers L, Ruhe HG, Peeters F. Effectiveness of psychotherapy for treatment-resistant depression: A meta-analysis and meta-regression. Psychol Med. 2019;49(3):366-379. doi:10.1017/S003329171800199X
Mura G, Moro MF, Patten SB, Carta MG. Exercise as an add-on strategy for the treatment of major depressive disorder: A systematic review. CNS Spectr. 2013;19(6):496-508. doi:10.1017/S1092852913000953
Sakurai H, Yonezawa K, Tani H, Mimura M, Bauer M, Uchida H. Novel Antidepressants in the Pipeline (Phase II and III): A Systematic Review of the US Clinical Trials Registry. Pharmacopsychiatry. 2022. doi:10.1055/a-1714-9097
Palhano-Fontes F, Barreto D, Onias H, et al. Rapid antidepressant effects of the psychedelic ayahuasca in treatment-resistant depression: A randomized placebo-controlled trial. Psychol Med. 2019;49(4):655-663. doi:10.1017/S0033291718001356
Morishita T, Fayad SM, Higuchi M aki, Nestor KA, Foote KD. Deep Brain Stimulation for Treatment-resistant Depression: Systematic Review of Clinical Outcomes. Neurotherapeutics. 2014;11(3):475-484. doi:10.1007/s13311-014-0282-1
Widge AS, Deckersbach T, Eskandar EN, Dougherty DD. Deep brain stimulation for treatment-resistant psychiatric illnesses: What has gone wrong and what should we do next? Biol Psychiatry. 2016;79(4):e9-e10. doi:10.1016/j.biopsych.2015.06.005
Cretaz E, Brunoni AR, Lafer B. Magnetic seizure therapy for unipolar and bipolar depression: a systematic review. Neural Plast. 2015. doi:10.1155/2015/521398
