Transforming treatment-resistant depression (TRD) care in the Gulf Cooperation Council (GCC) countries: a narrative review of emerging therapies, advancements, and implementation barriers.

Treatment-resistant depression (TRD) remains a major clinical challenge in Gulf Cooperation Council (GCC) countries, where conventional therapies often yield incomplete remission and cause significant side effects. Ketamine, esketamine, and repetitive transcranial magnetic stimulation (rTMS) show clinical efficacy and feasibility in the region. Esketamine adoption is increasing, led by the United Arab Emirates and Qatar, where it is administered in controlled clinical settings. rTMS is being gradually integrated, with expansion through private providers in the UAE and Hamad Medical Corporation in Qatar. However, access is limited by regulatory challenges, high costs, infrastructure constraints, cultural stigma, limited insurance coverage, and workforce shortages. Strategic investments, policy reforms, and awareness initiatives are critical to embedding these treatments into mental health systems.

Study at a glance

Abstract

Treatment-resistant depression (TRD) remains a major clinical challenge worldwide and across the Gulf Cooperation Council (GCC) countries, where the burden of mental health disorders continues to rise. Conventional TRD therapies, including antidepressants, augmentation strategies, and electroconvulsive therapy (ECT), often result in incomplete remission and are associated with significant adverse effects, highlighting the need for innovative therapeutic approaches. This narrative review explores the mechanisms, clinical evidence, regional adoption, and recent advances of ketamine, esketamine, and rTMS in TRD, while examining barriers to implementation and outlining future directions for care in the GCC. Esketamine adoption is increasing in the GCC, with the United Arab Emirates (UAE) and Qatar leading implementation efforts. In both countries, esketamine and related treatments are currently administered in controlled clinical settings within leading psychiatry clinics. Region-specific governmental strategies, such as Qatar's national mental health initiatives, have further supported the structured introduction of these therapies. rTMS is also being gradually integrated into regional mental health services, with notable expansion through private providers in the UAE and Hamad Medical Corporation (HMC) in Qatar. Despite these advancements, access remains limited due to regulatory challenges, high costs, and infrastructure constraints. Implementation of these therapies may serve as a foundation for future regional mental health policies, although cultural stigma, limited insurance coverage, and workforce shortages continue to pose barriers. Novel therapies for TRD demonstrate clinical efficacy and feasibility in the GCC. Nevertheless, their wider adoption requires addressing accessibility challenges, reducing stigma, and expanding professional training. Strategic investments, policy reforms, and awareness initiatives will be critical to embedding these treatments into mental health systems and transforming TRD care in the region.