Defining Treatment-Resistant Depression In Adults

Welcome back to another Psychiatric Times Insights series. In this episode titled, ‘Defining Treatment-Resistant Depression,’ Benjamin Yudkoff led the conversation about the following questions:

How is treatment-resistant depression (TRD) defined, and how many patients with depression reach that threshold?

What standard treatments and augmentation strategies are typically tried before a patient with treatment-resistant depression moves to interventional care?

Benjamin Yudkoff highlighted that TRD has no absolute definition but is generally regarded as an inadequate response to 2 antidepressants of adequate dose and duration in the current episode. He explained that standard monoamine-based antidepressants and psychotherapies, collectively called treatment as usual, are accessible and typically covered by insurance, yet are not sufficient for roughly a third of patients. He then reviewed augmentation with second-generation antipsychotics, lamotrigine, lithium, and thyroid hormone, stressing the need to explain to patients why a medication from the antipsychotic class may be used for depression. He also called lithium underused when it is dosed carefully.

Throughout the conversation, the experts provide a comprehensive reflection on the field and the factors that may shape how clinicians approach care moving forward.

In the next episode, ‘Interventional Options for TRD: ECT, TMS, and Esketamine,’ Dr. Yudkoff will continue the discussion on treatment-resistant depression and highlight the interventional treatments available today and how patients and clinicians choose among them.