Today’s question is: How to manage treatment-resistant depression?

Here is a summary of this episode:

• The first step in the management of treatment-resistant depression (TRD) is adequate history taking and assessment for comorbidities and bipolar depression.
• Augmentation is more effective than switching. Adding lithium is effective particularly in suicidal patients. Modafinil and T3 have been shown to be good add-ons in patients with fatigue.
• Psychosocial interventions such as mindfulness CBT and behavioral activation have been shown to improve outcomes and prevent relapse of depression.
• Depression may have an underlying inflammatory component and it has been found in some studies that patients with raised CRP above 3 mg/dL did better with nortriptyline than with SSRIs.

 

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