[Clinical management of treatment-resistant depression].
Der Nervenarzt – May 01, 2024
Source: PubMed
Summary
When traditional antidepressants fail, innovative pharmacological therapies targeting the glutamatergic system show remarkable promise. Recent advances combine rapid-acting compounds like esketamine with experimental treatments, including carefully monitored psychedelics. Off-label use of certain medications offers additional options, creating a more comprehensive approach to treating severe depression.
Abstract
Treatment-resistant depression (TRD) is a complex disorder. Although no standardized definition has been established to date, there are promising and well-established treatment options for the condition. Looking at the current pharmacological and neuromodulatory strategies, there is an urgent need for fast-acting and well-tolerated treatment options. The search for new mechanisms of action goes beyond the monoamine hypothesis. For example, esketamine is already an established treatment method that is fast-acting and well tolerated, while psychedelics or esmethadone are currently still undergoing clinical trials. Compounds that can be used off-label, such as dextromethorphan or anti-inflammatory strategies are also presented. Pharmacological approaches that focus on the modulation of the glutamatergic system or belong to the class of psychedelics, appear to be of particular importance for current research and development. These particularly include substances that rapidly exert clinical effects and have a favorable side-effect profile.