Treatment-Resistant Depression: An Alternative Approach to Management

The subject is treatment-resistant depression (TRD) . . . specifically new management options for this common problem. Our speaker is B. Andrew Farah, MD, Chief of Psychiatry at the High Point Division at University of North Carolina Health Care system.In this podcast, Dr Farah focuses on 3 topics:
• Shortcomings of current therapy that make TRD so common.
• New insights into the genetic underpinnings of TRD.
• A new treatment paradigm that puts non-drug therapies, such as oral B vitamin complex supplementation, as first-line treatment ahead of conventional antidepressants.Disclosures:Speakers Panel: Accera, Avanir, Novartis, and SunovionRequested Speaker Panel membership with JayMacResearch Grants: AcceraReviewer for JCP and Future MedicineSUMMARY
• Low monoamines are symptoms of depression
• Blocking the reuptake of NTs: symptomatic relief vs curative?
• The root cause of depression is the inability to synthesize adequate monoaminesIntracellularly, high HCY correlates with low monoamines and low B vitamins, particularly B6, 9 and 12, which act as cofactors for enzymes in the HCY cycle and for B9, BH4
• Metabolism of HCY reduces its toxic burden and results in monoamine and antioxidant production
• Individuals who undergo stress and develop depression have been shown to have polymorphisms for one or more B vitamins, that result in inadequate metabolism of B vitamins to the co-factor forms needed
• These polymorphisms likely represent the true genetic vulnerability behind depression and many other disorders and morbidities