Changing the Paradigm for Treatment Resistant Depression: From Recognition to Acute Treatment and Chronic Management

Thursday, April 5: 9:30 AM  - 11:30 AM 
Master Clinician Session 
Mezzanine Level 
Room: Marriott Balcony A 
Treatment resistant depression (TRD) is a chronic, recurrent and progressive condition afflicting about a third of people with depression but accounting for the majority of its costs. Hampering advances in the care of TRD are a lack of consensus on the definition of TRD, difficulties in developing novel somatic therapies beyond serotonergic and aminergic medications and the scientific hyperfocus on the acute management of a chronic illness, ignoring the potential benefits of long-term therapeutic strategies including considerations about psychotherapy.
The session will provide an opportunity to develop a new perspective on TRD starting with the common pitfalls in the recognition of TRD (defining what is adequate treatment and what diagnoses can be mistaken for TRD), through the challenges of co-morbid diagnoses and how they should effect treatment decisions. We will then tackle the current pharmacological options and what strategies are in development for the future. We will then address the problem of staying so much in the acute phase of depression and what we miss by not taking a longer view of the illness. While most studies focus on patients meeting response criteria (a 50% drop in a depression rating scale score) within six weeks of novel intervention, we need to take a longer term vision. A 25% drop in a depression rating score for five years would provide a far better outcome than a 50% drop for six months.
We will review data from a recently published study on 800 patients with severe TRD followed for five years with and without vagus nerve stimulation added to treatment as usual. This is the largest and longest study ever reported in this population and underscores the need for a paradigm shift from acute intervention toward long term management.
Finally we will look at the critical role psychotherapy plays in treatment resistant depression. Chronic depression often causes changes in personality which need to be addressed through a thoughtful means which takes into account the differing needs of our patients.

Learning Objectives

1. Identify the common co-morbidities complicating the diagnosis of TRD.
2. Describe the differing goals of acute and chronic management of TRD.
3. Explain the objectives of psychotherapy in a TRD population. 


Scott Aaronson, MD, Sheppard Pratt Health System

Audience Level





Diversity - No


120 minutes



Treatment Approach

Experimental/Emerging Therapeutics