Resistant depression : potentiation strategies

International audienceLithium is among the most classically recommended add-on therapeutic ă strategy for the management of depressive patients showing unsuccessful ă response to standard antidepressant medications. ă The effectiveness of the add-on strategy with lithium requires achieving ă plasma levels above 0.5 mEq/L. ă Mood-stabilizing antiepileptic drugs such as carbamazepine, valproate ă derivatives or lamotrigine have not demonstrated conclusive therapeutic ă effects for the management of depressive patients showing unsuccessful ă response to standard antidepressant medications. ă Thyroid hormones are considered among the currently recommended add-on ă therapeutic strategy for the management of depressive patients showing ă unsuccessful response to standard antidepressant medications. ă The effectiveness of the add-on strategy with thyroid hormones requires ă achieving plasma concentration of TSH close to the lower limits at the ă normal range (0.4 mUI/L) or even below it. Second-generation ă antipsychotics such as aripiprazole or quetiapine have consistently ă demonstrated significant therapeutic effects for the management of ă depressive patients showing unsuccessful response to standard ă antidepressant medications. ă Second-generation antipsychotics however require the careful monitoring ă of both cardiovascular and metabolic adverse effects