Goals of Treatment of Treatment Resistant Depression

In this episode, Dr Anita Clayton and panelists discuss treatment goals in TRD.

Panelists passionately advocated for remission as the standard goal in TRD treatment, with one drawing a powerful parallel to oncology — arguing that depression, as a leading cause of global disability, deserves the same aggressive, remission-focused treatment approach used in cancer care. Research definitions of remission, such as a MADRS score of 10 or below, were considered insufficient; true remission was defined as restored wellness and quality of life.

A critical theme was the importance of tailoring treatment to individual patient preferences, particularly around side effects such as weight gain and sexual dysfunction, which directly impact adherence and long-term outcomes. One panelist shared a personal experience with migraine treatment to illustrate how intolerable side effects lead patients to abandon effective therapies — and how alternative delivery formats, such as intermittent administered treatments, can dramatically improve adherence.

Panelists also acknowledged that many patients — especially those who have endured numerous failed treatments — no longer know what to ask for, having normalized feeling "less bad" as the best possible outcome. Clinicians were urged to proactively explore patient priorities rather than waiting for patients to articulate preferences they may not even know they have.

In the next episode, “Different approaches for Management of Treatment Resistant Depression,” panelists discuss the sequential management of TRD — from dose optimization and augmentation to neuromodulation and esketamine — while weighing the risks and benefits of available pharmacological options.