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Treatment Options for the Patient Who Does Not Respond Well to Initial Antidepressant Therapy

Preskorn, Sheldon H., MD

Journal of Psychiatric Practice®: May 2009 - Volume 15 - Issue 3 - p 202-210
doi: 10.1097/01.pra.0000351880.30013.2a

This column is the third in a series that began in January, 2009 on the improved understanding of and ability to treat patients with major depression. This column focuses on options for the patient who has not benefitted from one or more adequate trials of currently available antidepressants. It begins with a summary of the results of the switching and augmentation strategies studied in the landmark Sequenced Treatment Alternatives to Relieve Depression (STAR*D) study, funded by the National Institute of Mental Health (NIMH). The column then discusses options not included in the STAR*D study, including aripiprazole, which is now the first medication approved by the U.S. Food and Drug Administration (FDA) as adjunctive therapy for the treatment of patients with clinical depression, and vagus nerve stimulation, delivered by the first implantable device approved by the FDA for the treatment of patients with treatment-resistant depression (TRD). The goal of this column to summarize the data supporting various options for the busy clinician who treats such patients.

Professor, Department of Psychiatry, University of Kansas School of Medicine-Wichita, and Chief Executive Officer and Medical Director, Clinical Research Institute, Wichita, Kansas

He has more than 30 years of drug development research experience at all levels (ie, preclinical through Phase IV) and has been a principal investigator on over 250 clinical trials including every antidepressant marketed in the United States over the last 25 years. Dr Preskorn maintains a website at ( where readers can access previous columns and other publications

This column is adapted with permission from portions of Chapter 12 in Preskorn SH. Outpatient management of depression. Caddo, OK: Professional Communications; 2009:223–55.

Disclosure statement: Dr Preskorn, as chief executive officer of the Clinical Research Institute, Wichita, KS, and, in many cases, as principal investigator, has received grants from the following entities: AstraZeneca, Biovail, Boehringer-Ingelheim, Bristol-Myers Squibb, CoMentis, Cyberonics, Dainippon Sumitomo, Eisai, EnViVo, GlaxoSmithKline, Merck, Memory, Organon, Otsuka, Pfizer, Sepracor, Somerset, Wyeth, and the National Institute of Mental Health. He has served as a consultant, on the advisory board, and/or as a speaker for the following: Biovail, Bristol-Myers Squibb, CoMentis, Covedien, Cyberonics, Dainippon Sumitomo, Eli Lilly, EnViVo, Evotec, Fabre-Kramer, Jazz, Lundbeck, Memory, Organon, Pfizer, Somerset, Takeda, Transcept, and Wyeth.

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