Major Depressive Disorder ( Mdd )

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Introduction Major depressive disorder (MDD) is currently labeled one of the world’s greatest health problems, with an estimated prevalence of 4.7% and the second highest cause of years lived with a disability in 2010. The economic impact on patients with MDD is extensive particularly in patients that do not respond to treatment. Severe MDD can lead to loss of productivity and increase mortality. There remain several antidepressant treatments (ADTs) available to patients with MDD, but there is a significant minority that do not respond to first-line treatments. Secondary treatment options, including changing the current ADT or adding another ADT to the treatment regimen, such as a second generation antipsychotic. Currently, aripiprazole and quetiapine are the approved therapies in the United States for unresponsive MDD patients, including the adjunctive usage of fluoxetine and olanzapine. Their efficacy has been proven countless times in randomized controlled trials of these agents, but their tolerability profiles has limited their clinical usage. Side effects fluctuate between medications, but most regularly comprise of akathisia for aripiprazole, increased appetite and weight gain for olanzapine-fluoxetine combination, and excessive sedation for quetiapine. Weight gain can be a particularly menacing side effect as it increases a patient’s overall risk of metabolic abnormalities; extrapyramidal symptoms (EPS) which is equally linked with eventual risk of tardive

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