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Refractory Depression Management

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1. Guidance on the clinical management of depressive and bipolar disorders, specifically focusing on diagnosis and treatment strategies

Guidance on the clinical management of depressive and bipolar disorders, specifically focusing on diagnosis and treatment strategies First published in Australian and New Zealand Journal of Psychiatry 2015, Vol. 49(12) 1-185. Royal Australian and New Zealand College of Psychiatrists clinical practice guidelines for mood disorders Gin S Malhi 1,2 , Darryl Bassett 3,4 , Philip Boyce 5 , Richard Bryant 6 , Paul B Fitzgerald 7 , Kristina Fritz 8 , Malcolm Hopwood 9 , Bill Lyndon 10,11,12 , Roger (...) Mulder 13 , Greg Murray 14 , Richard Porter 13 and Ajeet B Singh 15 Abstract Objectives: To provide guidance for the management of mood disorders, based on scientific evidence supplemented by expert clinical consensus and formulate recommendations to maximise clinical salience and utility. Methods: Articles and information sourced from search engines including PubMed and EMBASE, MEDLINE, PsycINFO and Google Scholar were supplemented by literature known to the mood disorders committee (MDC) (e.g

2015 Royal Australian and New Zealand College of Psychiatrists

2. Refractory Depression Management

Refractory Depression Management Refractory Depression Management Toggle navigation Brain Head & Neck Chest Endocrine Abdomen Musculoskeletal Skin Infectious Disease Hematology & Oncology Cohorts Diagnostics Emergency Findings Procedures Prevention & Management Pharmacy Resuscitation Trauma Emergency Procedures Ultrasound Cardiovascular Emergencies Lung Emergencies Infectious Disease Pediatrics Neurologic Emergencies Skin Exposure Miscellaneous Abuse Cancer Administration 4 Refractory (...) Depression Management Refractory Depression Management Aka: Refractory Depression Management , Depression Unresponsive to Medication From Related Chapters II. Management: Step 1 Assess Maximize non-medication therapies (e.g. , psychotherapy) See Assess Adequacy of trial Minimum Duration: 6-8 weeks Minimum Dose: one dose increase at 2-4 weeks Assess for comorbid confounding factors Increased Psychosocial Stressors or Excessive intake Chronic medical illness Assess Compliance Has patient abruptly

2018 FP Notebook

3. Transcranial magnetic resonance-guided focused ultrasound and deep brain stimulation for refractory depression

the Australian community more than $600 million each year in treatment payments, and individuals with treatment- resistant depression contribute a disproportionate amount to the cost. People with depression that does not respond to conventional treatment are frequent users of healthcare services, and treatment costs for refractory depression may be up to 19 times greater than for patients who respond to treatment with medication and psychotherapy. The management of treatment-resistant depression involves (...) of the burden of disease due to depression. Available data, such as those captured through hospital admissions by the Australian h Email sent 28 July 2016; the contact was forwarded to the managing director of MediGroup to respond to Australian enquiries regarding ExAblate. i Brief information about the use of ExAblate is available from the MediGroup website. DBS and tcMRg FUS for refractory depression: December 2016 5 Institute of Health and Welfare, and data on the population living with mental health

2016 COAG Health Council - Horizon Scanning Technology Briefs

4. The prevalence, risk factors, and prognostic value of anxiety and depression in refractory or relapsed acute myeloid leukemia patients of North China. Full Text available with Trip Pro

The prevalence, risk factors, and prognostic value of anxiety and depression in refractory or relapsed acute myeloid leukemia patients of North China. This study aimed at investigating the prevalence of anxiety and depression, and their risk factors as well as their correlation with prognosis in refractory or relapsed (R/R) acute myeloid leukemia (AML) patients.A total of 180 R/R AML patients were enrolled and their anxiety and depression were assessed by Hospital Anxiety and Depression Scale (...) Eastern Cooperative Oncology Group score and lines of salvage therapy were correlated with anxiety and depression in R/R AML patients (all P < .05). Furthermore, anxiety and depression were associated with shorter overall survival (OS) in R/R AML patients (all P < .05), while no association of different degrees of anxiety and depression with OS was observed (all P > .05).Anxiety and depression are highly prevalent and implicated in the management and prognosis of R/R AML.

2019 Medicine

5. A Long Term Study of ALKS 5461 in the Treatment of Refractory Major Depressive Disorder (MDD)

A Long Term Study of ALKS 5461 in the Treatment of Refractory Major Depressive Disorder (MDD) A Long Term Study of ALKS 5461 in the Treatment of Refractory Major Depressive Disorder (MDD) - Full Text View - ClinicalTrials.gov Hide glossary Glossary Study record managers: refer to the if submitting registration or results information. Search for terms x × Study Record Detail Saved Studies Save this study Warning You have reached the maximum number of saved studies (100). Please remove one (...) or more studies before adding more. A Long Term Study of ALKS 5461 in the Treatment of Refractory Major Depressive Disorder (MDD) The safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Listing a study does not mean it has been evaluated by the U.S. Federal Government. Read our for details. ClinicalTrials.gov Identifier: NCT03610048 Recruitment Status : Enrolling by invitation First Posted : August 1, 2018 Last Update Posted : November 28, 2018

2018 Clinical Trials

6. Trial of MR-guided Focused Ultrasound for Treatment of Refractory Major Depression

Trial of MR-guided Focused Ultrasound for Treatment of Refractory Major Depression Trial of MR-guided Focused Ultrasound for Treatment of Refractory Major Depression - Full Text View - ClinicalTrials.gov Hide glossary Glossary Study record managers: refer to the if submitting registration or results information. Search for terms x × Study Record Detail Saved Studies Save this study Warning You have reached the maximum number of saved studies (100). Please remove one or more studies before (...) adding more. Trial of MR-guided Focused Ultrasound for Treatment of Refractory Major Depression The safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Listing a study does not mean it has been evaluated by the U.S. Federal Government. of clinical studies and talk to your health care provider before participating. Read our for details. ClinicalTrials.gov Identifier: NCT03421574 Recruitment Status : Recruiting First Posted : February 5, 2018 Last

2018 Clinical Trials

7. Vagus Nerve Stimulation for chronic major depressive episodes

in Table 1. Table 2 Proposed MBS item descriptors, as per the ratified PICO Confirmation Category 3 - THERAPEUTIC PROCEDURES Vagus nerve stimulation using an ELECTRICAL PULSE GENERATOR (subcutaneous placement of) to stimulate the left vagus nerve, for management of patients (aged 18 years of age or older) with a chronic major depressive episode who have not had an adequate response to four or more appropriate antidepressant treatments (i.e. at least four medications have been tried for sufficient time (...) to stabilise dose and manage side effects, before an assessment of failure of therapeutic effect is made) Multiple Services Rule (Anaes.) (Assist.) Fee: $340.60 Benefit: 75% = $255.45 (In-hospital/admitted patient only) Category 3 - THERAPEUTIC PROCEDURES Vagus nerve stimulation using an ELECTRICAL PULSE GENERATOR (surgical re-positioning or removal of), for management of patients (aged 18 years of age or older) with a chronic major depressive episode who have not had an adequate response to four or more

2019 Medical Services Advisory Committee

8. Backing into the future: pharmacological approaches to the management of resistant depression. Full Text available with Trip Pro

Backing into the future: pharmacological approaches to the management of resistant depression. Pragmatic studies indicate that a substantial number of depressed patients do not remit with current first-line antidepressant treatments and after two failed treatment steps the chance of remission with subsequent therapies is around 15%. This paper focuses on current evidence for pharmacological treatments in resistant depression as well as possible future developments. For patients who have failed (...) of the pathophysiological role of inflammation in depression offers great opportunities for future treatment in terms of repurposing anti-inflammatory agents from general medicine and pre-treatment stratification of those depressed patients in whom such interventions are likely to be beneficial. Finally an older drug, the dopamine receptor agonist pramipexole, if used carefully may well improve the prospects of depressed patients who are refractory to current approaches.

2017 Psychological Medicine

9. Royal Australian and New Zealand College of Psychiatrists clinical practice guidelines for mood disorders: major depression summary

personalised care to the individual, and delivering care in the context of a therapeutic relationship. In practice, the management of depression is determined by a multitude of factors, including illness severity and putative aetiology, with the principal objectives of regaining premorbid functioning and improving resilience against recurrence of future episodes. Main recommendations: The guidelines emphasise a biopsychosocial lifestyle approach and provide the following specific clinical recommendations (...) : Alongside or before prescribing any form of treatment, consideration should be given to the implementation of strategies to manage stress, ensure appropriate sleep hygiene and enable uptake of healthy lifestyle changes. For mild to moderate depression, psychological management alone is an appropriate first line treatment, especially early in the course of illness. For moderate to severe depression, pharmacological management is usually necessary and is recommended first line, ideally in conjunction

2018 MJA Clinical Guidelines

10. Transcranial Magnetic Stimulation for Major Depression and Schizophrenia

two different classes of antipsychotic drugs given for a minimum of four weeks. TRANSCRANIAL MAGNETIC STIMULATION FOR MAJOR DEPRESSION AND SCHIZOPHRENIA | SAX INSTITUTE 7 Preface The Report on evidence for Transcranial Magnetic Stimulation for Major Depression and Schizophrenia (the Report) has been commissioned by the NSW Ministry of Health as a nomination of the NSW new health technology evaluation program. A project management group (PMG), including the NSW Health Chief Psychiatrist, key (...) of emotions via facial expression or voice tone), reduced feelings of pleasure in everyday life, difficulty beginning and sustaining activities and diminished speaking. Cognitive symptoms arise as a result of deficits in memory, attention and learning ability. As with depression, schizophrenia is diagnosed based on DSM-V and ICD-10 criteria. Management For the management of depression during initial depressive episodes patients receive pharmacotherapy and psychosocial therapy based on severity of symptoms

2018 Sax Institute Evidence Check

11. Chronic heart failure in adults: diagnosis and management

Chronic heart failure in adults: diagnosis and management Chronic heart failure in adults: diagnosis Chronic heart failure in adults: diagnosis and management and management NICE guideline Published: 12 September 2018 nice.org.uk/guidance/ng106 © NICE 2019. All rights reserved. Subject to Notice of rights (https://www.nice.org.uk/terms-and-conditions#notice-of- rights).Y Y our responsibility our responsibility The recommendations in this guideline represent the view of NICE, arrived at after (...) of 35% or less and and who are already taking a stable dose of angiotensin-converting enzyme (ACE) inhibitors or ARBs. [2016] [2016] 1.4.23 Treatment with sacubitril valsartan should be started by a heart failure specialist with access to a multidisciplinary heart failure team. Dose titration and monitoring should be performed by the most appropriate team member as defined in NICE's guideline on chronic heart failure in adults: diagnosis and management [1] . [2016] [2016] 1.4.24 This guidance

2018 National Institute for Health and Clinical Excellence - Clinical Guidelines

12. Pancreatic cancer in adults: diagnosis and management

Pancreatic cancer in adults: diagnosis and management P Pancreatic cancer in adults: diagnosis and ancreatic cancer in adults: diagnosis and management management NICE guideline Published: 7 February 2018 nice.org.uk/guidance/ng85 © NICE 2019. All rights reserved. Subject to Notice of rights (https://www.nice.org.uk/terms-and-conditions#notice-of- rights).Y Y our responsibility our responsibility The recommendations in this guideline represent the view of NICE, arrived at after careful (...) care should be agreed and delivered. 1.4 Psychological support 1.4.1 Throughout the person's pancreatic cancer care pathway, specifically assess the psychological impact of: fatigue pain gastrointestinal symptoms (including changes to appetite) nutrition anxiety depression. 1.4.2 Provide people and their family members or carers (as appropriate) with information and support to help them manage the psychological impact of pancreatic cancer on their lives and daily activities. This should

2018 National Institute for Health and Clinical Excellence - Clinical Guidelines

13. A Study of ALKS 5461 for Treatment Refractory Major Depressive Disorder (MDD)

A Study of ALKS 5461 for Treatment Refractory Major Depressive Disorder (MDD) A Study of ALKS 5461 for Treatment Refractory Major Depressive Disorder (MDD) - Full Text View - ClinicalTrials.gov Hide glossary Glossary Study record managers: refer to the if submitting registration or results information. Search for terms x × Study Record Detail Saved Studies Save this study Warning You have reached the maximum number of saved studies (100). Please remove one or more studies before adding more (...) . A Study of ALKS 5461 for Treatment Refractory Major Depressive Disorder (MDD) The safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Listing a study does not mean it has been evaluated by the U.S. Federal Government. of clinical studies and talk to your health care provider before participating. Read our for details. ClinicalTrials.gov Identifier: NCT03188185 Recruitment Status : Recruiting First Posted : June 15, 2017 Last Update Posted : March

2017 Clinical Trials

14. Esketamine for Treatment-Resistant Depression

duration of esketamine treatment and whether it can eventually be tapered or discontinued. Furthermore, there is a lack of evidence comparing intranasal esketamine to current adjunctive strategies for TRD. References Lam RW, McIntosh D, Wang J, et al. Canadian Network for Mood and Anxiety Treatments (CANMAT) 2016 clinical guidelines for the management of adults with major depressive disorder: section 1. disease burden and principles of care. Can J Psychiatry. 2016;61(9):510-523. Depression and other (...) guidelines for the management of adults with major depressive disorder: section 3. pharmacological treatments. Can J Psychiatry. 2016;61(9):540-560. Ketamine for treatment-resistant depression or post-traumatic stress disorder in various settings: a review of clinical effectiveness, safety, and guidelines. (CADTH Rapid response report: summary with critical appraisal) . Ottawa (ON): CADTH; 2017: . Accessed 2019 Jan 28. Serafini G, Howland RH, Rovedi F, Girardi P, Amore M. The role of ketamine

2019 CADTH - Issues in Emerging Health Technologies

15. Chronic refractory dyspnoea. Evidence based management

depression in opioid-naïve pal- liative care patients during symptomatic therapy of dyspnea with strong opioids? j Palliat Med 2008;11:204–16. 18. Currow DC, Abernethy AP , Frith P . Morphine for management of refractory dyspnoea. bMj 2003;327:1288–9. 19. Ander DS, Aisiku IP , Ratcliff jj, Todd Kh, Gotsch K. Measuring the dyspnea of decompensated heart failure with a visual analog scale: how much improvement is meaningful? Congest heart Fail 2004;10:188–91. 20. Karras Dj, Sammon ME, Terregino CA, lopez (...) Chronic refractory dyspnoea. Evidence based management clinical Background Chronic refractory dyspnoea is defined as breathlessness daily for 3 months at rest or on minimal exertion where contributing causes have been treated maximally. Prevalent aetiologies include chronic obstructive pulmonary disease, heart failure, advanced cancer and interstitial lung diseases. Objective To distil from the peer reviewed literature (literature search and guidelines) evidence that can guide the safe

2013 Clinical Practice Guidelines Portal

16. British guideline on the management of asthma

British guideline on the management of asthma SIGN158 British guideline on the management of asthma A national clinical guideline First published 2003 Revised edition published July 2019Key to evidence statements and recommendations Levels of evidence 1 ++ High-quality meta-analyses, systematic reviews of RCTs, or RCTs with a very low risk of bias 1 + Well-conducted meta-analyses, systematic reviews, or RCTs with a low risk of bias 1 – Meta-analyses, systematic reviews, or RCTs with a high risk (...) at the time of publication. However, in the event of errors or omissions corrections will be published in the web version of this document, which is the definitive version at all times. This version can be found on our web site www.sign.ac.uk NHS Evidence has accredited the process used by Scottish Intercollegiate Guidelines Network to produce clinical guidelines. Accreditation is applicable to guidance produced using the processes described in SIGN 50: a guideline developer’s handbook, 2011 edition

2019 SIGN

17. Guidance on the clinical management of anxiety disorders, specifically focusing on diagnosis and treatment strategies

Guidance on the clinical management of anxiety disorders, specifically focusing on diagnosis and treatment strategies Objective: To provide practical clinical guidance for the treatment of adults with panic disorder, social anxiety disorder and generalised anxiety disorder in Australia and New Zealand. Method: Relevant systematic reviews and meta-analyses of clinical trials were identified by searching PsycINFO, Med- line, Embase and Cochrane databases. Additional relevant studies were (...) Australian and New Zealand College of Psychiatrists clinical practice guidelines for the treat- ment of panic disorder, social anxiety disorder and generalised anxiety disorder provide up-to-date guidance and advice on the management of these disorders for use by health professionals in Australia and New Zealand. Keywords Guidelines, panic disorder, agoraphobia, social anxiety disorder, generalised anxiety disorder, management, treatment Executive summary Anxiety is normal Anxiety can be good for us

2018 Royal Australian and New Zealand College of Psychiatrists

18. Depression with Psychotic Features Management

Administration 4 Depression with Psychotic Features Management Depression with Psychotic Features Management Aka: Depression with Psychotic Features Management From Related Chapters II. Management: First Line Agents ( ) ( ) III. Management: Other Agents and Perphenazine (Triavil) s (not as effective) IV. Management: Refractory Cases Images: Related links to external sites (from Bing) These images are a random sampling from a Bing search on the term "Depression with Psychotic Features Management." Click (...) Depression with Psychotic Features Management Depression with Psychotic Features Management Toggle navigation Brain Head & Neck Chest Endocrine Abdomen Musculoskeletal Skin Infectious Disease Hematology & Oncology Cohorts Diagnostics Emergency Findings Procedures Prevention & Management Pharmacy Resuscitation Trauma Emergency Procedures Ultrasound Cardiovascular Emergencies Lung Emergencies Infectious Disease Pediatrics Neurologic Emergencies Skin Exposure Miscellaneous Abuse Cancer

2018 FP Notebook

19. Depression Medical Management

Management Depression Medical Management Aka: Depression Medical Management , Medical Management of Depression From Related Chapters II. General Providers tend to under dose depression Refractory Depression may simply need higher levels Duration of therapy after remission of symptoms Young: 6 months minimum treatment Elderly: 2 years minimum use Rebound Depression off medication: Indefinite use Continued use reduces relapse risk by two thirds III. Protocol Choosing an Consider Consider Depression Types (...) : Anxiety ( ) ( ) VII. Management: Pain ( ) ( ) VIII. Management: Psychotic Depression See IX. Management: Inhibited Depression First Line: ( ) ( ) Second Line: ( ) ( ) Protriptyline (Vivactil) X. Management: Sexual Dysfunction See Man with Premature Ejaculation: Woman lacks orgasm: 30 minutes prior to sex Agents least likely to affect sexual function ( ) ( ) ( ) ( ) ( ) XI. Management: Perimenopausal Major Depression effective as XII. Management: Depression Refractory to Antidepressants See XIII

2018 FP Notebook

20. Mental health: Study supports augmentation with a non-antidepressant agent over combining or switching antidepressants in unipolar depression

Mental health: Study supports augmentation with a non-antidepressant agent over combining or switching antidepressants in unipolar depression Study supports augmentation with a non-antidepressant agent over combining or switching antidepressants in unipolar depression | BMJ Evidence-Based Medicine We use cookies to improve our service and to tailor our content and advertising to you. You can manage your cookie settings via your browser at any time. To learn more about how we use cookies, please (...) . Context Fifty per cent of patients with a major depressive disorder (MDD) do not yield a satisfactory response to an antidepressant. Even after several treatment approaches, the rate of patients with refractory depression is still 30%. 1 In case of non-response to therapy, adding a drug from a different pharmaceutical class to the antidepressant treatment has been shown to have an augmentative effect. 2 Most evidence is available for augmentation with lithium 3 and atypical antipsychotics. 4 Evidence

2018 Evidence-Based Medicine

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