Manejo de la Depresión Resistente al Tratamiento (DRT) en adolescentes.

Abstract

The management of Treatment-Resistant Depression (TRD) in adolescents is a relevant challenge. It arises when conventional treatments fail to improve and personalized approaches are required. This research seeks the best therapeutic options, considering advanced pharmacological interventions, emerging biological therapies and complementary psychotherapeutic strategies for comprehensive well-being. Objective: To establish the best therapeutic options for the management of treatment-resistant depression in adolescents. Methods: This research is a systematic review of the literature that was carried out through databases such as Scielo, ScienceDirect, Researchgate, PubMed, Cochrane and LILACS. Results: Some authors define it as a lack of response to two adequate pharmacological treatments for 4 to 8 weeks. Research has identified pharmacological treatments (such as ketamine and esketamine) that have shown efficacy but safety needs to be evaluated and non-pharmacological treatments (such as electroconvulsive therapy and transcranial magnetic stimulation) that have limitations. It is necessary to combine pharmacological and psychotherapeutic interventions. Intranasal esketamine is promising in severe depression but its long-term safety is still under evaluation. Psychotherapy complements improving results and alternatives such as psilocybin and ayahuasca are being explored. Conclusions: TRD is a psychiatric condition where Major Depressive Disorder does not improve despite adequate treatment. It is shown that there is no unique solution and individualized strategies are needed ranging from monotherapy to dose increase, substitution, combination, association with psychotropic drugs, alternative therapies. There are encouraging results with intravenous ketamine and intranasal esketamine and there are innovations such as transcranial magnetic stimulation (TMS) at 10 Hz. Combined interventions are more effective than single treatments, psychosocial therapies are useful but without established efficacy, the efficacy of ketamine/esketamine in acute treatment is evident in higher degrees of resistance to antidepressants.