This is a paper from the British Journal of Psychopharmacology about treating the residual symptoms of depression. The article is not a systematic review or meta-analysis but could be described instead as a structured review. The author begins by pointing out that one third of people with depression fail to respond to antidepressants of appropriate dose and duration. He also quotes the NIMH Epidemiological Catchment Area survey which showed that people with residual depressive symptoms were twice as likely to require ‘public assistance’ as those without – and so there is already a convincing argument for addressing these symptoms. Fava then goes on to describe some other implications of these symptoms.
Fava breaks down the residual symptoms into the categories of anxiety, sleep disturbance, somonolence or fatigue, apathy and cognitive or executive dysfunction. In terms of anxiety Fava identifies research showing the efficacy of augmentation with benzodiazepines and then identifies other medications which may be of benefit. However it is unclear what length of time they were prescribed for. The interplay between antidepressants and residual symptoms in different categories is also discussed.
In his discussion of insomnia, the author points out some very interesting research showing some significant improvements in depression scores with hypnotic augmentation where indicated. For each of the categories there is a corresponding table of suggested medications. There is a briefer discussion of fatigue although there is an interesting discussion of modafanil augmentation in this regards. In the sections on apathy and cognitive dysfunction there are some useful discussions and in the table of suggested medications in both categories I found some surprising inclusions (which got me thinking).
Whilst it is a brief paper, the strength of this article by Fava is that there is a clear and structured approach to looking at residual symptoms. One must bear in mind local or national guidelines in relation to the suggestions within this paper. Also, in some senses, the article acts as a starting point for further reading around the various topics. Well worth a look.
Fava M. Pharmacological approaches to the treatment of residual symptoms. Journal of Psychopharmacology. 20(3). 2006. 29-34.
The comments made here represent the opinions of the author and do not represent the profession or any body/organisation. The comments made here are not meant as a source of medical advice and those seeking medical advice are advised to consult with their own doctor. The author is not responsible for the contents of any external sites that are linked to in this blog.