Management of Treatment-Resistant Depression: Challenges and Strategies

Title	Management of Treatment-Resistant Depression: Challenges and Strategies
Authors	Daphne Voineskos, Zafiris J Daskalakis, Daniel M Blumberger
Magazine	Neuropsychiatric Disease and Treatment
Date	01/21/2020
DOI	10.2147/NDT.S198774
Introduction	Treatment-resistant depression (TRD), a form of Major Depressive Disorder, presents a significant challenge as it fails to respond to conventional first-line treatments. While various definitions and staging models for TRD exist, a unified consensus remains elusive. A consistent characteristic across these models is an insufficient response to at least two trials of antidepressant pharmacotherapy. This manuscript offers a thorough examination of current literature concerning the complexities and management approaches for TRD. A PubMed search was conducted to gather meta-analyses, clinical trials, and reviews pertinent to TRD. Initially, this work discusses the ambiguities in TRD definitions and staging, alongside the inherent difficulties in illness assessment. It then reviews pharmacological augmentation strategies, such as lithium, triiodothyronine, and second-generation antipsychotics, as well as the strategy of switching antidepressant classes. Somatic interventions, encompassing various brain stimulation techniques such as electroconvulsive therapy, repetitive transcranial magnetic stimulation, magnetic seizure therapy, and deep brain stimulation, are detailed. Psychotherapeutic approaches and emerging treatments, including ketamine, psilocybin, anti-inflammatory agents, and future directions, are also covered. The assembled evidence highlights the need for additional extensive investigations to clarify optimal treatment pathways for TRD and to offer effective therapeutic solutions for individuals affected by this condition.
Quote	Daphne Voineskos, Zafiris J Daskalakis and Daniel M Blumberger. Management of Treatment-Resistant Depression: Challenges and Strategies. Neuropsychiatr Dis Treat. 2020. Vol. 16:221-234. DOI: 10.2147/NDT.S198774
Element	Lithium (Li)