For treatment-resistant depression (TRD), a panel of 10 psychiatrists reached strong consensus on recommending augmentation with second-generation antipsychotics, transcranial magnetic stimulation, and ketamine/esketamine as next-step treatments after three failed antidepressant trials. Treatment preferences shifted to include nonaugmentative antidepressants and electroconvulsive therapy depending on patient characteristics such as metabolic disease and age. The findings underscore the importance of tailoring TRD treatment strategies to individual patient factors beyond conventional guideline tiers.
A commentary responds to an earlier article advocating for clinical trials of psychedelic-assisted therapy in adolescents aged 16 to 17. The authors agree that rigorous studies of compounds like psilocybin, LSD, and MDMA in this age group are warranted, as adolescents are likely already using these substances therapeutically. They offer additional considerations to foster further dialogue and advocacy in the field.