Managing Treatment-Resistant Depression: Insights From David Medina, MD, FAPA

CONFERENCE REPORTER

In the United States, an estimated 21 million adults have had at least 1 major depressive disorder (MDD) episode.¹ Selective serotonin reuptake inhibitors, while highly effective in some individuals with MDD, are only partially effective or ineffective in up to 50% of patients.²

David Medina, MD, FAPA, presented his session, "Breaking Barriers in the Management of Treatment-Resistant and Difficult-to-Treat Depression," at the Southern Florida Psychiatry Conference in West Palm Beach, Florida.

As part of his presentation, Medina discussed the "neuroplasticity hypothesis," a new way of thinking about depression that "may provide a better framework for clarification the pathogenesis of MDD and antidepressant efficacy."³

"The mainstream understanding of depression and how antidepressants work remained the same for approximately 50 years. It was focused on monoaminergic system," said Medina.

New medications like ketamine have a rapid onset of action. "Sometimes you can see results in hours. This is very important because depression is the leading cause of disability and suicidality," shared Medina.

Dr Medina is the president, medical director, and principal investigator at Nova Psychiatry, in Orlando, FL.

References

1. Major depression. National Institute of Mental Health. Accessed December 2, 2025. https://www.nimh.nih.gov/health/statistics/major-depression

2. Rush AJ, Trivedi MH, Wisniewski SR, et al. Acute and longer-term outcomes in depressed outpatients requiring one or several treatment steps: a STAR*D report. Am J Psychiatry 2006;163:1905-1917.

3. Liu B, Liu J, Wang M, et al. From serotonin to neuroplasticity: evolvement of theories for major depressive disorder. Front Cell Neurosci. 2017:11:305.