Citation

Chan LF, Woon LSC, Mohd Shukor NA, Eu CL, Ismail N, Chin SJ, Nik Jaafar NR, Baharudin A. Front. Psychiatry 2022; 13.

Copyright

(Copyright © 2022, Frontiers Media)

DOI

10.3389/fpsyt.2022.890099

PMID

unavailable

Abstract

A significant proportion of patients with treatment-resistant depression do not attain functional recovery despite administration of multiple steps of pharmacotherapeutic strategies. This highlights the elusiveness of meeting unmet needs in existing pharmacotherapies for treatment-resistant depression. There is accumulating evidence that antidepressant agents involving the glutamatergic system such as brexpiprazole and esketamine/ketamine have more rapid onset of action and potentially improved effectiveness as an augmentation therapy in treatment-resistant depression. This case series aimed to report five complex cases of unipolar and bipolar treatment-resistant depression where conventional treatment strategies were inadequate in managing high risk suicidal behavior and achieving functional recovery. We discussed further the possible synergistic mechanisms of the novel combination strategy of brexpiprazole and esketamine/ketamine, clinical and patient factors that influenced treatment response, challenges with this combination strategy and implications for future practice and research. Copyright © 2022 Chan, Woon, Mohd Shukor, Eu, Ismail, Chin, Nik Jaafar and Baharudin.

Language: en

Keywords

adult; human; suicide; female; male; case report; insomnia; psychotherapy; ketamine; suicidal ideation; physical activity; major depression; bipolar depression; disease severity; posttraumatic stress disorder; mood disorder; visual impairment; hopelessness; psychoeducation; clinical article; cognitive defect; mirtazapine; xerostomia; automutilation; headache; quetiapine; social psychology; physical examination; middle aged; anxiety disorder; electroconvulsive therapy; borderline state; drug efficacy; guilt; drug tolerability; nausea; lorazepam; irritability; valproic acid; relapse; zolpidem; lamotrigine; hypomania; escitalopram; clonazepam; dose response; Chinese; obsessive compulsive disorder; psychosocial withdrawal; anhedonia; dizziness; aripiprazole; auditory hallucination; Article; Southeast Asia; drug dose titration; outcome assessment; dry eye; agomelatine; treatment resistant depression; combination drug therapy; cognitive behavioral therapy; treatment-resistant depression; vortioxetine; depression assessment; middle income country; Malay (people); esketamine; brexpiprazole; congenital glaucoma; effectiveness; Self report Quick Inventory of Depressive Symptomatology; treatment resistant bipolar type II depression