Clinical guidelines for the management of treatment-resistant depression: French recommendations from experts, the French Association for Biological Psychiatry and Neuropsychopharmacology and the fondation FondaMental

Bennabi, Djamila; Charpeaud, Thomas; Yrondi, Antoine; Genty, Jean-Baptiste; Destouches, S.; Lancrenon, S.; Alaīli, N.; Bellivier, Frank; Bougerol, Thierry; Camus, Vincent; Dorey, Jean‐Michel; Doumy, Olivier; Haesebaert, Frédéric; Holtzmann, Jérôme; Lançon, Christophe; Lefèbvre, M.; Molière, Fanny; Nieto, Isabel; Rabu, Corentin; Richieri, Raphaëlle; Schmitt, Laurent; Stéphan, Florian; Vaïva, Guillaume; Walter, Michel; Leboyer, Marion; El‐Hage, Wissam; Llorca, Pierre Michel; Courtet, Philippe; Aouizerate, Bruno; Haffen, Emmanuel

doi:10.1186/s12888-019-2237-x

Cited by 70 publications

(59 citation statements)

References 45 publications

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“…They also may signal risk of residual symptoms, such as sleep disturbances, executive impairments and anxiety [ 13 ]. They are considered by a group of experts as great indicators of prognosis and severity of TRD [ 14 – 16 ]. Identifying their relationship with cerebral functioning could improve resistance management and selection of potential cerebral therapeutic targets.…”

Section: Discussionmentioning

confidence: 99%

Brain SPECT perfusion and PET metabolism as discordant biomarkers in major depressive disorder

et al. 2020

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Background Brain SPECT perfusion and PET metabolism have been, most often interchangeably, proposed to study the underlying pathological process in major depressive disorder (MDD). The objective of this study was to specify similarities and inconsistencies between these two biomarkers according to global characteristics of the disease. We conducted a retrospective study in 16 patients suffering from treatment-resistant MDD who underwent, during the same current episode, a cerebral perfusion SPECT with 99mTc-HMPAO and a metabolic PET with 18F-FDG. Whole-brain voxel-based SPM(T) maps were generated in correlation with the number of depressive episodes and in correlation with the depression duration, separately for the two exams (p-voxel < 0.001 uncorrected, k > 20). Results No significant correlations were found between brain metabolism and either the number of depressive episodes or the duration of the disease, even at an uncorrected p-voxel < 0.005. On the other hand, the increased number of depressive episodes was correlated with decreased perfusion of the right middle frontal cortex, the right anterior cingulum cortex, the right insula, the right medial temporal cortex and the left precuneus. The increased depression duration was correlated with decreased perfusion of the right anterior cingulum cortex. Conclusions This preliminary study demonstrates more significant results with brain perfusion compared with glucose metabolism in treatment-resistant MDD, highlighting the value of brain SPECT despite less favourable instrumentation detection compared to PET.

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Section: Discussionmentioning

confidence: 99%

Brain SPECT perfusion and PET metabolism as discordant biomarkers in major depressive disorder

et al. 2020

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“…venlafaxine), as well as an increasing number of other types of recent antidepressants (such as bupropion and mirtazapine), besides the older tricyclic and monoamine oxidase inhibitor drugs [4][5][6][7][8][9].…”

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confidence: 99%

QbD-driven development of intranasal lipid nanoparticles for depression treatment

Vitorino

Silva

Gouveia

et al. 2020

European Journal of Pharmaceutics and Biopharmaceutics

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Depression is a life-threatening psychiatric disorder and a multifactorial global public health concern. Current pharmacological treatments present limited efficacy, and are associated with several harmful side effects and development of pharmacoresistance mechanisms. Developing more effective therapeutic options is therefore a priority. This work aims at efficiently designing an antidepressant therapeutic surrogate relying on a dual strategy supported on lipid nanoparticles and intranasal delivery. For that purpose, the formulation was comprehensively optimized following a quality by design perspective. Critical quality attributes (CQAs) ranged from physicochemical to intranasal performance features. The optimized formulation was administered to mice in order to assess the antidepressive and anxiolytic effects by applying the forced swimming and marble-burying tests, respectively. A cross-analysis of the predictive models established for the set of 12 CQAs elicited the formulation containing similar proportion of solid and liquid lipids and lower surfactant concentration as the optimal one. Despite increasing the liquid lipid amount yielded smaller and more homogeneous particle size, and higher release rate, nanostructured lipid carriers (NLCs) provided an earlier and superior pig nasal mucosa permeability than nanoemulsions, along with better stability and cytotoxic profiles. Importantly, the intranasal delivery of the optimal lipid nanoparticle formulation reduced both depressive and anxiety-like behaviors, which positions these intranasal nanosystems in line with the hypothesis of provisioning timely and better acting antidepressant therapies. 1. Introduction Depression is a life-threatening mental disorder and a major public health concern, affecting more than 300 million people of all ages worldwide [1]. It leads to disability, noteworthy health-related costs and decreased quality of life, being considered a prominent risk factor for many other diseases, including neuropsychiatric, cardiovascular, and metabolic conditions [2,3]. Conventional pharmacological treatments for depression are considered relatively well defined. Antidepressant standard-of-care comprises oral selective serotonin reuptake inhibitors (SSRIs, e.g. fluoxetine) and serotonin-norepinephrine reuptake inhibitors (SNRIs, e.g.

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“…A recent systematic review did not reveal any guidelines developed specifically for TRD, 2 but in 2019, the French Association for Biological Psychiatry and Neuropsychopharmacology published “Clinical guidelines for the management of treatment-resistant depression”. 88 In addition, some MDD guidelines do contain recommendations for TRD diagnosis and treatment. 58 , 59 , 67 …”

Section: Resultsmentioning

confidence: 99%

<p>Management of Treatment-Resistant Depression in Real-World Clinical Practice Settings Across Asia</p>

Wang

Han

Liu

et al. 2020

NDT

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Purpose: Consensus is lacking on the management of treatment-resistant depression (TRD), resulting in significant variations on how TRD patients are being managed in real-world practice. A survey explored how clinicians managed TRD across Asia, followed by an expert panel that interpreted the survey results and provided recommendations on how TRD could be managed in real-world clinical settings. Methods: Between March and July 2018, 246 clinicians from Hong Kong, Japan, Mainland China, South Korea, and Taiwan completed a survey related to their treatment approaches for TRD. Results: The survey showed physicians using more polytherapy (71%) compared to maintaining patients on monotherapy (29%). The most commonly (23%) administered polytherapy involved antidepressant augmentation with antipsychotics that 19% of physicians also indicated as their most important approach for managing TRD. The highest number of physicians (34%) ranked switching to another class of antidepressants as their most important approach, while 16% and 9% chose antidepressant combinations and electroconvulsive therapy (ECT), respectively. Conclusion: Taking into account the survey results, the expert panel made general recommendations on the management of TRD. TRD partial-responders to antidepressants should be considered for augmentation with second-generation antipsychotics. For non-responders, switching to another class of antidepressants ought to be considered. TRD patients achieving remission with acute treatment should consider continuing their antidepressants for at least another 6 months to prevent relapse. ECT is a treatment consideration for patients with severe depression or persistent symptoms despite multiple adequate trials of antidepressants. Physicians should also consider the response, tolerability and adherence to the current and previous antidepressants, the severity of symptoms, comorbidities, concomitant medications, preferences, and cost when choosing a TRD treatment approach for each individual patient.

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Clinical guidelines for the management of treatment-resistant depression: French recommendations from experts, the French Association for Biological Psychiatry and Neuropsychopharmacology and the fondation FondaMental

Cited by 70 publications

References 45 publications

Brain SPECT perfusion and PET metabolism as discordant biomarkers in major depressive disorder

Brain SPECT perfusion and PET metabolism as discordant biomarkers in major depressive disorder

QbD-driven development of intranasal lipid nanoparticles for depression treatment

<p>Management of Treatment-Resistant Depression in Real-World Clinical Practice Settings Across Asia</p>

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