Treatment-resistant depression (TRD) has a fairly low barrier of entry. Failure of 2 full antidepressant trials—lasting 6 weeks at a minimally effective dose—is enough to qualify. In this month’s issue of TCPR, we’ll highlight pharmacologic advances that are underutilized and debunk a few that are unlikely to be effective for TRD.

We often come across patients who seem stuck in a repetitive, negative style of thinking that we call rumination. Rumination is often associated with depression or anxiety, and when severe, it can seem akin to psychosis.

Treatment-resistant depression (TRD) is not untreatable. The challenge is to keep hope alive and the patient engaged in recovery. “You deserve, and can expect, a full recovery,” I’ll often tell patients, “but we’re going to need more than medications to get you there.” I’ll then offer a choice: to either start weekly psychotherapy or make a lifestyle change—or both.

Here’s a common scenario. You have a patient who has tried three or four antidepressants over the years; all have been somewhat effective at least initially, but eventually that effectiveness waned.

This study tested a self-guided mobile app in patients with moderate to severe depression who had not responded to at least 1 antidepressant trial. The Japanese app, called ­Kokoro, used cartoon characters to present concepts from CBT, including self-monitoring, behavioral activation, and cognitive restructuring.

The post-test for this issue is available for one year after the publication date to subscribers only. By successfully completing the test you will be awarded a certificate for 2 CME credits.

After reading these articles, you should be able to…

You may have read about the meta-analysis published in Lancet earlier this year on the efficacy evidence for all antidepressants (Cipriani A et al, Lancet 2018;391(10128):1357–1366). It’s a complicated paper, and in this article, we’ll take a closer look at it and give you our take on the bottom line.

The most common cause of parkinsonism is Parkinson disease, but parkinsonism also can occur from the use of any medication that blocks the D2 (dopamine type 2) receptor. Those include antipsychotics but can also include non-psychiatric medicines, particularly metoclopramide (Reglan), an anti-nausea medicine.