Recent Advances in the Treatment of Treatment-Resistant Depression: A Narrative Review of Literature Published from 2018 to 2023
John L. Havlik, Syed Wahid, Kayla M. Teopiz, Roger S. McIntyre, John H. Krystal, Taeho Greg Rhee
Current Psychiatry Reports April 1, 2024 Peer reviewed DOI: 10.1007/s11920-024-01494-4 via Springer Nature
Summary
Recent advances in treating treatment-resistant depression (TRD) have expanded best practices, especially for interventional psychiatric approaches. Psychotherapy can be effective as an adjunctive treatment but not as monotherapy. Little recent evidence supports adjunctive non-antidepressant pharmacotherapies like buprenorphine or antipsychotics, as side effects and discontinuation rates may outweigh benefits. Strong evidence supports interventional approaches including electroconvulsive therapy, ketamine/esketamine, and transcranial magnetic stimulation. Research on TRD should use internationally defined guidelines for study inclusion to improve generalizability.
Study at a glance
| Design | review |
|---|---|
| Key finding | Recent evidence supports interventional approaches like electroconvulsive therapy, ketamine/esketamine, and transcranial magnetic stimulation for treatment-resistant depression, while adjunctive non-antidepressant pharmacotherapies have limited support due to side effects. |
Abstract
Purpose of Review We review recent advances in the treatment of treatment-resistant depression (TRD), a disorder with very limited treatment options until recently. We examine advances in psychotherapeutic, psychopharmacologic, and interventional psychiatry approaches to treatment of TRD. We also highlight various definitions of TRD in recent scientific literature. Recent Findings Recent evidence suggests some forms of psychotherapy can be effective as adjunctive treatments for TRD, but not as monotherapies alone. Little recent evidence supports the use of adjunctive non-antidepressant pharmacotherapies such as buprenorphine and antipsychotics for the treatment of TRD; side effects and increased medication discontinuation rates may outweigh the benefits of these adjunctive pharmacotherapies. Finally, a wealth of recent evidence supports the use of interventional approaches such as electroconvulsive therapy, ketamine/esketamine, and transcranial magnetic stimulation for TRD. Summary Recent advances in our understanding of how to treat TRD have largely expanded our knowledge of best practices in, and efficacy of, interventional psychiatric approaches. Recent research has used a variety of TRD definitions for study inclusion criteria; research on TRD should adhere to inclusion criteria based on internationally defined guidelines for more meaningfully generalizable results.