PHARMACOLOGICAL CHOICES AFTER ONE ANTIDEPRESSANT FAILS - A SURVEY OF UK PSYCHIATRISTS

Background: At least 30% of depressed patients fail to respond to adeq uate first-line anti-depressant medication. Several pharmacological st rategies have been suggested to treat such refractory depression. Ther e has been no survey of United Kingdom psychiatrists' treatment prefer ences for refractory depression. This study was carried out to determi ne both experience and preference of various strategies for management of refractory depression. Method: A total of 300 fellows, members and inceptors of the Royal College of Psychiatrists were randomly selecte d and approached by postal questionnaire. They were asked to comment o n management of a detailed clinical vignette of a case of depression w ith initial treatment failure. Results: The response rate was 63% (n = 175). The most popular treatment choices were increasing dosage of tr icyclic medication and change of medication to SSRT. The most rarely s elected were augmentation with triiodothyronine (T3) and augmentation with tryptophan or MAOIs. Treatment choice was significantly influence d by previous experience. A large number (39%) of psychiatrists were n ot confident in treating refractory depression. Conclusion: Surprising ly few, psychiatrists chose to use the best proven pharmacological tre atments such as augmentation with lithium or T3. In view of this and t he considerable proportion of psychiatrists lacking confidence in the management of refractory depression, this topic deserves priority as a topic for continuing professional development (CPD) courses. (C) 1997 Elsevier Science B.V.