Treatment Resistant Depression and Well-Rounded Care, with Alejandro Alva at Southern California Psychiatry

CONFERENCE REPORTER

Developments in interventional psychiatry like transcranial magnetic stimulation, ketamine, and vagal nerve stimulation provide exciting new options for treatment resistant depression, shared Alejandro Alva, MD at the Southern California Psychiatry Conference.1

Alva discussed that there is a need to recognize the differentiation between treatment resistant depression and depression that is difficult to treat. Alva focused on the multitude of techniques that are now available to providers in treating depression in patients that have not responded well to traditional treatments. Alva stated “what we want to put out to the general public and to our colleagues is that there are multiple treatment modalities that can be used.” Oftentimes providers focus on medication management, which is important, but Alva emphasized the need to look further. Other available treatment options within interventional psychiatry might include transcranial magnetic stimulation (TMS) and vagal nerve stimulation, which he noted are becoming mainstays for intervention.2 Ketamine and esketamine can also be an option, showing that providers are not limited to one option and are free to explore the growing number of treatments.

Alva pointed out that psychotherapy is also an essential element in treating this disorder. He said he tells patients “you have a biological nature or genesis of your depression, you have a psychosocial genesis of your depression…we need to address what’s happening in your life.” Addressing all aspects of a patient's life and including new advances in depression treatment will likely provide better outcomes, he predicts. Alva was excited about the growing future of interventions for treatment resistant depression, and noted that "interventional psychiatry is really coming into its own” in the current moment.

Dr Alva is the founder, chief medical officer, and CEO of Pacific Neuropsychiatric Specialists. He has been practicing psychiatry for more than 20 years.

References

1. Alva A. Treatment-resistant and difficult-to-treat depression: definitions and illness burden. Conference Proceedings of the Southern California Psychiatry Conference. July 2025;11-12. Huntington Beach, CA.

2. Somani A, Kar SK. Efficacy of repetitive transcranial magnetic stimulation in treatment-resistant depression: the evidence thus far. Gen Psychiatr. 2019;32(4):e100074.