Highlights from 2024 NEI Synapse: The Road Forward: Guidelines for the Detection and Management of Treatment-Resistant Depression
Friday, April 19, 2024
Major depressive disorder (MDD) can be difficult to treat and if patients do not respond to treatment MDD can progress to Treatment Resistant Depression or TRD. Unfortunately, there isn’t a consensus within the psychiatry community as to what the exact definition of TRD is and how many treatment trials a patient must undergo to meet the criteria for TRD. Despite the lack of concrete criteria for TRD, roughly 30% of those with MDD will go on to be diagnosed with TRD.
Due to the lack of consensus surrounding the definition of TRD, Dr. Roger McIntyre focused this presentation on his recent published criteria covering how to diagnose and treat TRD. Specifically, Dr. McIntyre addresses the definition of TRD and implement the Thase and Rush system for staging antidepressants where a patient is considered treatment resistant after only 1 failed trial of an antidepressant. To expand on this point, Dr. McIntyre makes the argument that providers must focus on a patients tendency towards anhedonia because anhedonia strongly predicts poor antidepressant outcomes. Therefore, if a patient exhibits a strong tendency towards anhedonia, the provider can be more comfortable treating the patient as having TRD. Thus, by utilizing Dr. McIntyre’s system for assessing and treating TRD, providers can have confidence in an algorithmic approach to treating patients struggling with depression.
Lastly, and perhaps most importantly, Dr. McIntyre notes that psychiatry should move away from the term “Treatment Resistant Depression” and instead utilize “Difficult to Treat Depression” or “DTD.” Dr. McIntyre notes that this is an important paradigm shift because it prevents the patient from assuming they are “treatment resistant,” which may give patients a sense of hopelessness. By adopting a DTD approach, Dr. McIntyre notes that communicating with the patient and their support system is much more important. For example, TRD emphasizes a biomedical cure through pharmacotherapy where the patient ends a trial either meeting the criteria for remission or not. A DTD approach takes a chronic illness approach, where we assume the patient may struggle and not be cured, but by managing symptoms from a biopsychosocial approach, we will reduce the impact of depressive symptoms. Overall this presentation by Dr. McIntyre drives home the point that taking a DTD collaborative approach with the patient and their support system will result in more patient-centered care, increased treatment statisfaction, and improved clinical outcomes.
Source:
Roger S. McIntyre, MD, FRCPC. The Road Forward: Guidelines for the Detection and Management of Treatment-Resistant Depression. Presented April 19 at 2024 NEI Synapse, Las Vegas, NV.
To Learn More: The recording of these presentations, as well as all of the other presentations from the 2024 NEI Synapse, will be available as Encore Presentations for NEI Members.