Treatment-resistant depression (TRD)
- Reconfirm diagnosis, adherence + adequate trials
- Optimize current antidepressant before switching
- Switch or augment by partial vs no response
- Augment: atypical antipsychotic or lithium
- Esketamine is FDA-approved for TRD
- IV ketamine is evidence-based off-label
- ECT is most effective for severe refractory illness
Use at a glance
- Reconfirm diagnosis, adherence + adequate trials
Practical pearls
- Optimize current antidepressant before switching
Treatment options
- Switch or augment by partial vs no response
- Augment: atypical antipsychotic or lithium
- Esketamine is FDA-approved for TRD
- IV ketamine is evidence-based off-label
Escalation / refractory disease
- ECT is most effective for severe refractory illness
Self-check
- What is optimized before switching in TRD?
The current antidepressant. - Which treatment is most effective for severe refractory depression?
ECT.
Drugs used for this (7)
All clinical uses · Open Treatment-resistant depression (TRD) in the interactive console ↗