Attuned to the Needs of Patients

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SPECIAL REPORT: TREATMENT-RESISTANT DEPRESSION

How attuned are mental health clinicians to the needs of patients who do not achieve wellness right away? Current trends in the psychiatric setting evoke a keen interest in being able to rein in treatment-resistant depression (TRD). Included in this Special Report of Psychiatric Times are articles regarding the details of managing major depressive disorder (MDD) and TRD.

MDD wreaks havoc by disrupting patients’ lives and increasing the likelihood of morbidity and mortality. COVID-19 further clarified the viciousness with which MDD manifests and accentuated the fact that therapies that should work do not always do so.

Current guidelines espouse the use of pharmacotherapy and psychotherapy for those with moderate to severe MDD, but up to 50% of patients may not respond to treatment and may require changes to their intervention, leading to delayed improvement and increased likelihood of decline and suffering. This disastrous condition erodes well-being and demoralizes the patient.

Nomenclature differs in what TRD entails. The more accepted definition states a patient lacks sufficient benefit from 2 or more treatments but can be as extreme as 4 inadequate responses before vagus nerve stimulation can be considered as a treatment option.

The advent of oral treatments that allow discussions and interventions beyond the consideration of monoamines and look at glutamate and γ-aminobutyric acid has helped propel us toward achieving a better outcome for patients.

We need to continually revisit our previous paradigms and treatment strategies that were noted in the outdated STAR*D study, the real-world paradigm of incorporating augmentation strategies with atypical antipsychotics, and leveraging cognitive behavioral therapy, even if said treatment is virtually managed. Doing so broadens our ability as psychiatric practitioners to better manipulate MDD and TRD.

The therapeutic landscape for MDD and TRD has shifted to better address the needs of our patients. It is now up to us to remain up to date with practical, manageable applications that also address overall wellness and logical recommendations, including hydration, nutrition, activity (physical and mental), mindfulness, and healthy living.

Dr Alva is an assistant clinical professor at the University of California, Riverside School of Medicine in the Department of Psychiatry and Neuroscience. He is a distinguished fellow of the American Psychiatric Association and the Psychiatric Times Mood Disorders Section Editor.