Monday, 18 August 2003
This presentation is part of : Late-Life Mood Disorder: Significant Progress but Many Unanswered Questions

S013-002 If at First You Don’t Succeed…: Treatment-Resistant Depression in Late-Life

Alastair Flint, Department of Psychiatry, Department of Psychiatry, University of Toronto, Toronto, ON, Canada

‘Treatment-resistant depression’ is a descriptive term, meaning that a person’s depressive illness has not sufficiently improved with an adequate trial of treatment. Over the past 30 years, many research and clinical groups have proposed criteria to operationalize the concept of treatment-resistant depression. As yet, however, there is no widely accepted consensus. At least two key elements remain unresolved:

(a) the criteria for clinically meaningful improvement, and

(b) the number and type of treatment trials that a patient should experience before he or she is labeled as having a refractory depression.

This presentation discusses the concept of treatment-resistant depression and issues pertaining to its assessment and management in older patients. Key issues in the assessment of refractory depression include: accuracy of diagnosis; adequacy of treatment; and physical, psychiatric, and psychosocial factors that have the potential to impair response to treatment. The discussion of management will focus on standard approaches to treatment-resistant depression (augmentation, combination of antidepressants, switching antidepressants, and electroconvulsive therapy) and will highlight the benefit of using a systematic, stepped-care approach to treatment. The current status of repetitive transcranial magnetic stimulation and vagus nerve stimulation will also be addressed. Finally, data pertaining to the effect of treatment resistance on the longterm outcome of late-life depression will be presented.

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