We’re pleased to introduce Chris Aiken, MD, as the new editor-in-chief of The Carlat Psychiatry Report. Dr. Aiken is a clinician, researcher, and writer. He is the director of the Mood Treatment Center in North Carolina, where he maintains a private practice combining medication and therapy along with evidence-based complementary and alternative treatments.

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.