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Treatment-resistant depression in adolescents: review and updates on clinical management

Authors

  • Fadi T. Maalouf M.D.,

    Corresponding author
    1. Department of Psychiatry, American University of Beirut Medical Center, Beirut, Lebanon
    2. Western Psychiatric Institute and Clinic, Department of Psychiatry, University of Pittsburgh School of Medicine, Pennsylvania
    • American University of Beirut Medical Center, Riad el Solh Street, Beirut, Lebanon
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  • Mia Atwi B.A.,

    1. Department of Psychiatry, American University of Beirut Medical Center, Beirut, Lebanon
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  • David A. Brent M.D.

    1. Western Psychiatric Institute and Clinic, Department of Psychiatry, University of Pittsburgh School of Medicine, Pennsylvania
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  • The authors report they have no financial relationships within the past 3 years to disclose.

Abstract

Treatment-resistant depression (TRD) in adolescents is prevalent and impairing. We here review the definition, prevalence, clinical significance, risk factors, and management of TRD in adolescents. Risk factors associated with TRD include characteristics of depression (severity, level of hopelessness, and suicidal ideation), psychiatric and medical comorbidities, environmental factors (family conflict, maternal depression, and history of abuse), and pharmacokinetics and other biomarkers. Management options include review of the adequacy of the initial treatment, re-assessment for the above-noted factors that might predispose to treatment resistance, switching antidepressants, and augmentation with medication or psychotherapy. Other modalities, such as electroconvulsive therapy, vagal nerve stimulation, and repetitive transcranial magnetic stimulation, are also reviewed. Depression and Anxiety, 2011.  © 2011 Wiley Periodicals, Inc.

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