Treatment-Resistant Depression – Recognition and Treatment

Available with English captions.

The vast majority of those who struggle with clinical depression—also known as major depressive disorder (MDD)—are able to find relief through some combination of medication and traditional forms of therapy. However, for roughly 30% of those with MDD, antidepressants prove to be largely ineffective, and their depression is deemed to be treatment resistant.

So what is treatment-resistant depression (TRD), and how do you determine when a patient is a candidate for therapeutic approaches such as transcranial magnetic stimulation (TMS)? If TMS isn’t the best next step, what other options are out there?

Audience Questions:

Joshua C. Brown, MD, PhD, shares what makes some forms of depression especially difficult to treat, explores proven, cutting-edge treatment, and answers questions about lifestyle changes for helping manage TRD.

  • What is the difference between feeling down and being clinically depressed?
  • Is the term major depressive disorder (MDD) synonymous with clinical depression?
  • What are the diagnostic criteria that are standardized for something like MDD?
  • How many people struggle with clinical depression?
  • How treatable is MDD?
  • What is the definition of treatment-resistant depression (TRD)?
  • Is there a particular test or diagnosis that sets TRD apart from general clinical depression?
  • What causes TRD and what are some of the risk factors?
  • Are there certain conditions that tend to co-occur with depression?
  • Are there are any red flags or signs of TRD that a lay person can look for?
  • What are the distinctions between TRD and borderline personality disorder (BPD)?
  • What are the different forms of treatment available for TRD? What are the traditional and non-traditional therapies available for somebody with TRD?
  • What should one know about electroconvulsive therapy (ECT) for treating TRD?
  • Does vagus nerve stimulation (VNS) fall under the umbrella of neurostimulation?
  • What is transcranial magnetic stimulation (TMS) and how does it work?
  • How would you describe experiencing a TMS session? Is TMS uncomfortable for the patient?
  • If medication and ECT treatment do not work to alleviate depression, is TMS an option?
  • Is TMS safe for individuals with migraines or aneurysms?
  • What should parents know about TMS for teenagers?
  • What should we know about the use of psychedelics for TRD treatment?
  • Do most general practice clinicians spot the distinctions between MDD and TRD?
  • Does TMS tend to get covered under insurance?
  • What should we know about post-treatment life for somebody living with TRD? What does that look like?

Resources

About Dr. Brown

Joshua C. Brown, MD, PhD, is a psychiatrist and neurologist. He is medical director of the Transcranial Magnetic Stimulation (TMS) Service and director of TMS research in the Division of Depression and Anxiety Disorders at McLean Hospital. Dr. Brown is also director of the Brain Stimulation Mechanisms Laboratory at McLean.

Dr. Brown is working to advance TMS through service on the Clinical TMS Society’s board of directors, as a member-at-large and research committee co-chair. His research uses neurophysiology to measure TMS effects in combination with relevant receptor-modulation drugs in human subjects.

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