By Siegfried Kasper, Stuart A. Montgomery
The first ebook dedicated to a hard disease that has effects on hundreds of thousands of individuals round the world. crucial analyzing for all psychiatrists who deal with those patients.
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Extra resources for Treatment-resistant depression
Example text
Thus the current concept of TRD can be reduced to what people complain about or what doctors treat, or a combination of the two. Such a concept is fragile at its boundaries, as it expands or contracts with changes in medicosocial attitudes towards therapeutic optimisms. It is also at the mercy of idiosyncratic decisions taken by doctors or patients and is open to pharmaceutical manipulations. We therefore adopted the MSM, for its multidimensional and quantitative nature, to study a large sample of depressed Treatment-resistant depression: a separate disorder 29 inpatients in order to further analyse the characteristics of patients with different levels of TRD.
Interestingly, the receptor binding profile alone seems to be relevant to MDD pathophysiology and antidepressant effect. Indeed, a growing body of evidence suggests a decreased cortical 5-HT2A receptor binding in MDD patients compared with healthy controls (Dhaenen, 2001). The duration of the illness appears to be related to this feature: in first-episode subjects, no difference has been found compared to healthy controls, while TRD patients show lower 5-HT2A receptor binding in the dorsal regions of the prefrontal cortex and the ACC.
G. g. due to the G allele of rs6295) may lead to poor antidepressant response, but through different mechanisms. The effect of these two deleterious alleles may be even worse when they coexist in the same subject, probably resulting in TRD. 5-HTTLPR and rs6295 are the most investigated polymorphisms within the SLC6A4 and 5-HTR1A genes, but several other variants have also been reported to affect their expression and functionality. Therefore, although the concepts discussed in this section hold true, we must keep in mind that the real picture is even more complex.
