Submited on: 13 Mar 2015 02:52:52 PM GMT
Published on: 16 Mar 2015 06:38:50 AM GMT
 
Review of the Pharmacological Treatment of Resistant Depression
Posted by Mr. Matthew Cox on 20 Nov 2016 06:26:34 PM GMT Reviewed by Interested Peers

  • What are the main claims of the paper and how important are they?

    This paper claims to primarily do three things: give a definition of resistant depression, analyze the factors of resistant depression, and identify strategies of pharmacotherapy. These claims are important because as many as half of patients may exhibit some level of resistance to pharmacological intervention. 


  • Are these claims novel? If not, please specify papers that weaken the claims to the originality of this one.

    The claim that incorrect administration of pharmacotherapy (dose, drug, frequency, and duration of therapy) leads to pseudoresistance or artificial resistance is novel, however, many of the other claims have been investigated in other studies. For example, Maurizio Fava gives an excellent overview in "Diagnosis and definition of treatment resistant depression" published in Biological Psychiatry in 2003. Fava provides a succint definition of treatment resistant depression and categorizes adequate antidepressant pharmacotherapy. 


  • Are the claims properly placed in the context of the previous literature?

    The importance of gaining a correct diagnosis and maintaining patient adherence to therapy are stressed in current literature. However, the unique claim by the authors that mismanagment of drug therapy leads to pseudoresistance is a unique claim. The authors do provide a valuable process of thinking for clinicians in addressing treatment resistant depression. I believe that many top level practitioners proceed through this checklist when providing care to patients. 


  • Do the results support the claims? If not, what other evidence is required?

    I am curious as to how the authors measured response to pharmacotherapy in this study. Did they measure it through patient self reporting, drug levels in the blood, or a reduction in overall symptomology? Also, I am curious why they chose to utilize the DSM-IV in diagnosing their patients, when the DSM-V became available in 2013, especially since the paper was submitted to WebmedCentral in 2015. I wonder if altering the diagnostic criteria would change their inclusion criteria and potentially alter their patient population included in this study. 


  • If a protocol is provided, for example for a randomized controlled trial, are there any important deviations from it? If so, have the authors explained adequately why the deviations occurred?

    When reviewing the protocol, I did not notice any deviations from their protocol. However, I wonder what effect including some patients in a hospital setting and others in a clinic setting had on their results. Would it be easier for the patients in the hospital setting to adhere to a pharmacotherapy regimen than the patients in the clinic? What outcome would this have on the diagnosis of treatment resistant depression?


  • Is the methodology valid? Does the paper offer enough details of its methodology that its experiments or its analyses could be reproduced?

    This study provides enough detail that a clinician could perform an analysis of the pharmacotherapy strategies of a patient population. However, I am unsure if they would reach the same conclusions as the authors, because the response criteria was not included in the study description. Despite this omission, the study does offer unique and important insight into investigating the efficacy of a drug therapy regimen.


  • Would any other experiments or additional information improve the paper? How much better would the paper be if this extra work was done, and how difficult would such work be to do, or to provide?

    Perhaps updating the diagnostic criteria to DSM-V would be beneficial. Including more information about the analysis of response to pharmacotherapy would improve the overall quality of the study. In the "treatment plan" segment of the study, the authors referred to measuring blood levels of medications, I think coupling this data to the initial mismanagment of pharmacotherapy and how the levels changed once the drug therapy was corrected would make a stronger connection to a beneficial change. These changes would not require extensive additional research, but utilizing the data they already have. Including this information would improve the quality of the paper, in my opinion.


  • Is this paper outstanding in its discipline? (For example, would you like to see this work presented in a seminar at your hospital or university? Do you feel these results need to be incorporated in your next general lecture on the subject?) If yes, what makes it outstanding? If not, why not?

    This paper does provide interesting and insightful information into the clinical approach to treating resistant depression. I think the sections entitled "treatment plan to resistant depression" and "recommendations" would be useful for any practicing clinician. However, I am unsure of the frequency of mismanagment of pharmacotherapy, especially in experienced and competent practitioners. If this is a recurring problem, I believe the authors are well prepared to combat this issue. 


  • Other Comments:

    I am a pharmacy student interested in neuropharmacology, and I understand that as healthcare professionals, we have a responsibility to the patient to ensure they are receiving the most appropriate treatment possible. Taking the steps necessary to ensure correct diagnosis and adherence to an appropriate pharmacotherapy regimen is essential, and I believe the authors would agree that diligence is necessary when analyzing these clinical facets. I am pleased to know that both researchers and clinicians have the best interest of the patient in mind. I sincerely hope my review was succinct and constructive. 

  • Competing interests:
    .
  • Invited by the author to review this article? :
    No
  • Have you previously published on this or a similar topic?:
    No
  • References:

    .

  • Experience and credentials in the specific area of science:

    I am a pharmacy student interested in neuropharmacology with access to primary research through my university.

  • How to cite:  Cox M .Review of the Pharmacological Treatment of Resistant Depression[Review of the article 'Pharmacologic Treatment of Resistant Depression in Psychiatric Hospital ''Ali Mihali'' and in the Center of Community of the Mental Health (CCMH), Vlora (Albania) ' by Vyshka G].WebmedCentral 2016;7(11):WMCRW003323
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