The pharmacological treatment of tricyclic-resistant depression: review and management guidelines

Effect of recommended dosage range on the prescribing of antidepressants

The aim of the study was to explore the role that suggested dosage range may play in suboptimal prescribing practice of tricyclic antidepressants. Clinicians practising in adult psychiatry were shown a clinical vignette of melancholia (as per DSM-III-R). One of two questionnaires on treatment practices, specifying either 75-200 mg or 75-425 mg of an unnamed tricyclic antidepressant, were randomly distributed to subjects. A highly significant (p = 0.001) difference was found: those who were given a narrow dosage range prescribed an average of 82.5 mg/day less antidepressant than those for whom the dosage range had been widened, indicating that the range within which dosages are recommended affects prescribing practices. When erroneously constrained, the range may contribute toward sub-optimal prescribing practices and as a consequence toward treatment-resistant depression.

Treatment resistant depression in an Australian context. I: The utility of the term and approaches to management

The concept of "treatment resistant depression" (TRD) has generally been defined in terms of failure to respond to a standard course of somatic therapy with little reference to diagnostic sub-types or relevant psychosocial factors. In this paper we examine problems with the use of the term "treatment resistant depression" and then outline an approach to TRD employed in an Australian mood disorders unit. After discussing the need for a biopsychosocial assessment, multimodal management strategies for melancholic and non-melancholic TRD patients are described.

The Prince Henry Hospital Mood Disorders Unit

In 1985 a Mood Disorders Unit (MDU) was established at Prince Henry Hospital in Sydney as a clinical research module, linked with the psychiatric department of the University of New South Wales. There were three general objectives: first, to provide a specialized state-wide clinical service for the assessment and management of those with affective disorders, particularly treatment-resistant depression; secondly, to make a research contribution; and thirdly, to serve as an academic centre for teaching and training of undergraduate and postgraduate students from a variety of disciplines.