The first medication to achieve FDA approval to treat treatment resistant depression is a combination of two widely-prescribed drugs – an antidepressant and an antipsychotic.
The first antidepressant intended to combat treatment resistant depression, Symbyax, won FDA approval in March of 2009. Treatment resistant depression, or TRD, is diagnosed when the depression patient receives little or no relief after trial periods on two or more antidepressant medications, or when their symptoms improve but then return. TRD sufferers often feel like nothing will help them, and may give up hope of ever escaping their depressed mood.
Symbyax is a combination of two widely-prescribed medications - the antidepressant Prozac (fluoxetine hydrochloride) and the atypical antipsychotic Zyprexa (olanzapine), also marketed as orally disintegrating Zyprexa Zydis. Symbyax is recommended by its manufacturer, Eli Lilly, to treat both TRD and bipolar disorder.
Major depressive disorder is the leading cause of disability for Americans aged 15 to 44, and is almost twice as common in women as in men. Bipolar disorder affects about 5.7 million Americans. Traditional treatments for depression include therapy, electroconvulsive therapy, vagus nerve stimulation, transcranial magnetic stimulation and antidepressant medication.
Currently, the most commonly prescribed antidepressant medications are selective serotonin reuptake inhibitors (SSRIs) such as Prozac, serotonin-norepinephrine reuptake inhibitors (SNRIs) such as Effexor and Effexor XR, and the norepinephrine-dopamine reuptake inhibitor (NDRI) Wellbutrin and Wellbutrin XL. Bipolar disorder is traditionally treated with therapy and lithium or anti-convulsant medication.
Only about a third of depression patients respond fully to the first antidepressant medication they are prescribed, but most will eventually respond to a different antidepressant drug, or to a combination of antidepressant drugs. Combining medication with therapy yields the best results in mild to moderate depression. But clinical studies have found that as many as one in three depression patients may have a form of resistant depression.
Traditional resistant depression treatment with antidepressants involves changing the dosage of the initial drug, substituting another prescription antidepressant from the same or another class, combining two antidepressant drugs with different mechanisms of actions, or adding an antidepressant from another class. Augmenting one medication with another often yields the best results, but can also lead to an increase in common side effects.
Treatment resistant depression is likely caused by a combination of genetic and environmental factors, including not taking prescribed depression medications exactly as prescribed, ongoing stress, childhood abuse or neglect, chronic pain, substance abuse, or unrecognized underlying health conditions such as a thyroid disorder or anemia. Occasionally, a patient may be depression treatment resistant due to a misdiagnosed mental illness or an accompanying undiagnosed mental illness such as post-traumatic stress or panic disorder.
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