Daphne Voineskos

Department of Psychiatry, University of Toronto, Toronto, ON, Canada.

2 papers in the library · 430 citations · publishing 2020-2026

Papers

Management of Treatment-Resistant Depression: Challenges and Strategies

Neuropsychiatric Disease and Treatment January 1, 2020 Daphne Voineskos, Zafiris J. Daskalakis, Daniel M. Blumberger 430 citations

Treatment-resistant depression (TRD) is a form of major depressive disorder that does not respond to standard first-line treatments. Although no consensus definition exists, all models require an inadequate response to at least two trials of antidepressant medication. This review compiles meta-analyses, trials, and reviews on TRD challenges and management. It discusses confounds in definitions and staging, difficulties in assessment, and pharmacological augmentation strategies (lithium, triiodothyronine, second-generation antipsychotics, switching antidepressant class). Somatic therapies (electroconvulsive therapy, repetitive transcranial magnetic stimulation, magnetic seizure therapy, deep brain stimulation), psychotherapeutic approaches, and novel treatments (ketamine, psilocybin, anti-inflammatories) are reviewed. The evidence indicates that further large-scale work is needed to understand appropriate treatment pathways and prescribe effective options.

DOI: 10.2147/ndt.s198774 Treatment-resistant depression Major depressive disorder Anxiety Antidepressant +15

Symptom trajectories and clinical outcomes of intravenous ketamine in treatment-resistant depression: A real-world study using group-based trajectory modeling.

Journal of affective disorders January 23, 2026 Reinhard Janssen-Aguilar, Jithin Joseph, Huda Al-Shamali et al.

In a retrospective chart review of 209 adults with treatment-resistant depression treated with intravenous ketamine, depressive and anxiety symptoms improved significantly over four or six infusions, but the improvements were modest and highly variable across individuals. Anxiety symptoms improved more slowly and less robustly than depressive symptoms. End-of-treatment response and remission rates were numerically higher after six infusions than after four, but the difference was not statistically significant. Four distinct patterns of symptom change emerged for both depression and anxiety, highlighting the heterogeneity of treatment response. Durability after six infusions could not be assessed because follow-up data were available only for the four-infusion group.

DOI: 10.1016/j.jad.2026.121230 Full text Anxiety Treatment-resistant depression Iv ketamine Real-world evidence +1