Further, more than one medication might be required in the face of acute symptoms, such as aggression, or comorbid conditions, such as ADHD, he said.
Both experts emphasized the need to closely follow resistant patients if the diagnosis is correct and the medication dosage has been maximized.
“Persistence is important,” Dr. Brent said. “Most patients will eventually respond to treatment.”
If they don't respond, then revisit the diagnosis first, he advised, considering the possibility that what appears to be depression is really a manifestation of bipolar disorder, anxiety, an eating disorder, ADHD, or obsessive-compulsive disorder.
All of the above disorders also might be contributory to depression, complicating treatment. “You want to make sure that you are not missing things in dealing with someone who is treatment resistant,” Dr. Brent said.
Other considerations are compliance and metabolic absorption of a medication, the possibility of an undiagnosed medical condition such as hyper- or hypothyroidism, iron-deficiency anemia, or vitamin B12 deficiency; and critically, the psych osocial milieux.
“Even severely depressed adolescents generally respond if treatment is continued and approached systematically, involving sequential treatments and psychosocial interventions,” Dr. Emslie said.
Dr. Brent reported that he had no relevant financial conflicts of interest. Dr. Emslie has received research support from Biobehavioral Diagnostics Inc. and Somerset Pharmaceuticals, and has served as a consultant for Biobehavioral Diagnostics, Eli Lilly & Co., Forest Laboratories, Pfizer Inc., and Wyeth Pharmaceuticals.
By Betsy Bates. Share your thoughts and suggestions at cpnews@elsevier.com
'Even severely depressed adolescents generally respond if treatment is continued and [systematic].'
Source DR. EMSLIE