Systematic Reviews
Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Psychiatr. Sep 22, 2015; 5(3): 330-341
Published online Sep 22, 2015. doi: 10.5498/wjp.v5.i3.330
Pharmacologic approaches to treatment resistant depression: Evidences and personal experience
Antonio Tundo, Rocco de Filippis, Luca Proietti
Antonio Tundo, Rocco de Filippis, Luca Proietti, Istituto di Psicopatologia, Private Outpatients Clinic, 00196 Roma, Italy
Author contributions: Tundo A designed the research; Tundo A and de Filippis R contributed to the identification of trials and data extraction; Tundo A wrote the manuscript; Tundo A, de Filippis R and Proietti L designed the review, interpreted the results and edited the manuscript.
Conflict-of-interest statement: All the authors declare that they have no competing interests.
Data sharing statement: This article is not a basic research or clinical research study so has no data to share. No additional data are available than the articles cited in this review.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Antonio Tundo, MD, Istituto di Psicopatologia, Private Outpatients Clinic, via Girolamo da Carpi 1, 00196 Roma, Italy. tundo@istitutodipsicopatologia.it
Telephone: +39-6-3610955 Fax: +39-6-36002828
Received: May 18, 2015
Peer-review started: May 19, 2015
First decision: July 10, 2015
Revised: July 28, 2015
Accepted: August 20, 2015
Article in press: August 21, 2015
Published online: September 22, 2015
Core Tip

Core tip: According to the available evidences and our personal experience we suggest to treat patients non-responders: to one selective serotonin reuptake inhibitors antidepressants (SSRI), buproprion or mirtazapine trial by switching to venlafaxine; to one venlafaxine trial by switching to tricyclic antidepressants (TCA) or, if TCA are not tolerated, by combining mirtazapine with SSRI or venlafaxine; to two or more adequate antidepressant (AD) trials (including TCA if tolerate) by AD augmentation with lithium (mainly in patients with bipolar depression or suicidality), second generation antipsychotics (SGAs) (mostly aripiprazole) or dopamine-agonists (mostly pramipexole); to combination and augmentation strategies and elettroconvulsive therapy (ECT), if workable, by combination plus augmentation strategy. Combining the available evidences and our personal experience we suggest: for non-responders to one SSRI (buproprion or mirtazapine) trial switching to venlafaxine for non-responders to one venlafaxine trial switching to TCA, if TCA are not tolerated, combining mirtazapine with SSRI or venlafaxine. For non-responders to two or more AD trials (including TCA if tolerate) we suggest AD augmentation with lithium (bipolar depression or suicidality), SGAs (aripiprazole) or dopamine-agonists (pramipexole) for non-responders to combination and augmentation strategies and ECT, if possible, we suggest a combination plus augmentation strategy.