Venlafaxine and treatment-resistant depression

Treatment-resistant depression (TRD) is an important clinical problem. This paper briefly reviews the definition of TRD and summarizes methodological issues that pertain to treatment research. Recent studies of venlafaxine tr eatment for TRD also are reviewed. It is concluded that venlafaxine at high er noses is a reasonably, well-tolerated and an effective alternative for p atients with TRD and typically should be used before tricyclic antidepressa nts monamine oxidase inhibitors. Further research is needed to confirm the prediction that switching a SSRI nonresponder to venlafaxine is a more effe ctive strategy than switching to a second SSRI. The relative merits of swit ching from a SSRI to venlafaxine versus adding a norepinephrine reuptake in hibitor also warrant careful study. (C) 2000 Wiley-Liss, Inc.