Abstract
Antidepressant therapies, such as selective serotonin reuptake inhibitors (SSRIs), are current first-line treatments for Major Depressive Disorder. However, over 50% of treated patients show an inadequate response to initial antidepressant therapy. If the therapeutic outcomes from two antidepressant therapies are suboptimal, potentially resulting in Treatment Resistant Depression, subsequent strategies include switching to another antidepressant or augmenting treatment by combining with other agents. When combined with SSRIs, atypical antipsychotics have supplementary action on dopaminergic and noradrenergic systems. Studies on combined treatment with atypical antipsychotics have shown significantly increased remission rates, shortened response times, and favorable side effects. Augmentation of antidepressants with atypical antipsychotics is now an acceptable treatment strategy which leads to increased remission rates and better outcomes for patients.
Highlights
Major Depressive Disorder (MDD) is the third leading cause of disease burden worldwide [1] and will affect between 13-16% of people during the course of their lifetime [2,3]
Tricyclic antidepressants (TCAs) and monoamine oxidase inhibitors (MAOIs) were the first modern pharmacotherapies used for depression but have been less used lately because they are associated with problematic side effects and drug interactions; TCAs are associated with anticholinergic, antihistaminergic, and anti-α-1-adrenergic side effects, whereas MAOIs are associated with insomnia, sedation, and orthostatic hypotension [6]
The suggestive, yet preliminary, evidence of SAMe as an effective antidepressant in patients with treatment resistant major depressive disorder warrants confirmation in future studies so that SAMe might be recommended as a novel augmentation agent to the antidepressant therapy armamentarium
Summary
Major Depressive Disorder (MDD) is the third leading cause of disease burden worldwide [1] and will affect between 13-16% of people during the course of their lifetime [2,3]. Characterized by symptoms which include low mood, along with low self-esteem, and/or loss of interest or pleasure in normally enjoyable activities [4], the impact of depression can be severe. It causes significant impairment, poor social and occupational functioning, and is associated with high rates of psychiatric comorbidity, increased rates of physical health problems and raised mortality. Poor social and occupational functioning, and is associated with high rates of psychiatric comorbidity, increased rates of physical health problems and raised mortality Of those hospitalized with severe depression, approximately 16% eventually commit suicide [5]. This review focuses on depression as part of MDD
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