Abstract
Treatment-resistant depression is a state of inadequate therapeutic response to two different antidepressants from different pharmacological classes in a depressive episode. Such a treatment is difficult in all age categories.
In adults we use a variety of strategies backed up by published studies (treatment optimization, change of antidepressant medication, augmentation and combination of antidepressants). The treatment in child psychiatry is similar to adults.
However, levels of evidence for each strategy are significantly lower. In our case study we present an adolescent girl suffering from treatment-resistant depression.
Before admission to our clinic, the patient had been treated on an outpatient basis with two SSRI antidepressants (sertraline and fiuvoxamine) augmented with atypical antipsychotics (tiaprid, risperidone) with minimal effect. During the hospital stay we first optimized existing treatment with fiuvoxamine and risperidone, then we made a change to SNRI antidepressant monotherapy (venlafaxine).
Desired effect was not achieved even with higher doses of venlafaxine. Eventually combination therapy with venlafaxine and mirtazapine (NaSSA antidepressant) demonstrated to be effective and led to remission of a depressive disorder.